Port Community Church FALL 2024 KIDZ ZONE EVENTS "Attitude of Gratitude" - October 19 "Christmas Captions" - December 21
PORT COMMUNITY CHURCH 118 Main Street, Port Republic, NJ 08241
PREK3 - GRADE 5 10:00AM - 1:00PM (Includes Lunch)
CHILD'S NAME
*
First Name
Last Name
CURRENT GRADE
Please Select
PREK3
KINDERGARTEN
GRADE 1
GRADE 2
GRADE 3
GRADE 4
GRADE 5
CHILD'S BIRTHDATE
YOU CAN REGISTER FOR ONE OR BOTH OF THE KIDZ ZONE DATES RIGHT HERE:
ATTITUDE OF GRATITUDE - Saturday, October 18th (10AM-1PM)
CHRISTMAS CAPTIONS - Saturday, December 20th (10AM-1PM)
PLEASE LIST ANY MEDICAL CONCERNS, ALLERGIES, OR ANY OTHER CONCERNS THAT WE NEED TO BE ALERTED TO MAKE THIS THE BEST POSSIBLE EXPERIENCE.
PARENT NAME
First Name
Last Name
PARENT PHONE NUMBER
Please enter a valid phone number.
EMAIL
example@example.com
DESIGNATED PICK-UP PERSON
FIRST AND LAST NAME
PICK-UP PERSON PHONE NUMBER
Please enter a valid phone number.
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SIGNATURE PAGE
As per our Safe Church Plan, please note that all volunteers are screened and trained in safety protocols to ensure a safe and secure place of worship.
Pictures and videos will be taken during Kidz Zone activities by Port Community Church for use in our Craft Projects, Activities, Church social media, VBS Program. I hereby give my permission for my child to be included in the pictures
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INITIAL HERE
Medical Release: I (We), the parent(s) or guardian(s) of the above listed child(ren) grant permission for our child(ren) to participate in Kidz Zone Events at Port Community Church and to receive medical treatment if necessary. If I (we) or the listed child care provider or emergency contact cannot be reached, I (we) give our permission to the staff to secure the services of a licensed physician to provide necessary care, including anesthesia, for my child's well-being.
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INITIAL HERE
I (we) also release and agree to hold harmless Port Community Church and all its participants from any liability and assume all risk of injury, damage or expenses as the result of participation in activities in Kidz Zone events.
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SIGNATURE
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DATE
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