Port Community Church 2026 KIDZ ZONE & JR YOUTH
PORT COMMUNITY CHURCH 118 Main Street, Port Republic, NJ 08241 ALL ARE WELCOME so PASS THE WORD! KIDZ ZONE Coordinator: Michelle Robinson (732-619-6475) JR YOUTH Coordinator: Karen Harrison (732-600-7914) Email: office @portcommunitychurch.com
KIDZ ZONE: PREK3 - GRADE 3 JR YOUTH: GRADES 4-7 10:00AM - 12Noon
Sign up today for one or all! All Kidz Zones & JR Youth are FREE!
Are you registering for KIDZ Zone or JR Youth?
KIDZ ZONE (PreK3-Grade 3)
JR Youth (Grades 4-7)
CHILD'S NAME
*
First Name
Last Name
CURRENT GRADE
*
Please Select
PREK3
KINDERGARTEN
GRADE 1
GRADE 2
GRADE 3
GRADE 4
GRADE 5
GRADE 6
GRADE 7
CHILD'S BIRTHDATE
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
YOU CAN REGISTER RIGHT HERE: Sign up for the ones that you want to attend or ALL of them; however, please be sure to notify us if you are unable to attend. SAVE THE DATES!
May 16, 2026
September 19, 2026
October 17, 2026
November 21, 2026
December 19, 2026
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.
Format: (000) 000-0000.
EMAIL
*
example@example.com
DESIGNATED PICK-UP PERSON
FIRST AND LAST NAME
PICK-UP PERSON PHONE NUMBER
Please enter a valid phone number.
Format: (000) 000-0000.
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SIGNATURE PAGE - KIDZ ZONE & JR YOUTH 2026
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 & Jr Youth 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 & JR Youth 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 AND JR Youth.
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SIGNATURE
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DATE
*
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Month
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Day
Year
Date
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