Kids Club: Participant Registration 2024

Parent/Guardian Section
Parent/Guardian Info:
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Primary Phone*
Primary Phone Type*
Secondary Phone
Secondary Phone Type
E-mail*
How would you like to volunteer?*
Medical/Allergy/Emergency Contact Information
Medical Conditions:
Any medical conditions about your child that will help us should an emergency occur.
Known Allergies:
Any known allergies that your child has that will help direct us in making decisions for your child.
Behavior Concerns:
Any behavioral conditions about your child that will be helpful to us.
Emergency Contact: Same as Parent/Guardian?

Yes
Emergency Contact Name #1:*

First NameLast NameRelationship
Emergenct Contact Phone #1:*
Emergency Contact Name #2:

First NameLast NameRelationship
Emergenct Contact Phone #2:
Dismissal: Who can pick up your child(ren)?
Pick-up person on site?

Yes
Same as Parent/Guardian?

Yes
Authorized Pickup #1*

First NameLast NameRelationship
Authorized Pickup #2

First NameLast NameRelationship
Authorized Pickup #3

First NameLast NameRelationship
Authorized Pickup #4

First NameLast NameRelationship
Church Affiliation
Church Member Status:
Church Affiliation:
Name of Church You Attend (if any)
Guest Of:

First NameLast Name
Comments/Questions
Should be Empty: