Kids Corner Registration Form
Please review all required areas for ages 5-11.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Format: (000) 000-0000.
How many children are coming with you? (Children under 4 years old may not come to Kid's Corner.)
*
Please select dates listed below in which you and your toddler will be joining us from 9:00 a.m. - 11:00 a.m.
*
September 19, 2026
October 3, 2026
October 17, 2026
November 7, 2026
November 21, 2026
December 5, 2026
Does your child(ren) have any allergies we should know about?
*
Please Select
Yes
No
Does your child(ren) have any special needs we should know about?
Read the following statements and check the boxes to agree to the terms:
*
I understand and agree that I cannot leave my child(ren) unattended before, during, or after Kids Corner.
I understand and agree that snacks will be offered and if my child(ren) has an allergy, I will provide my child(ren) with their own snack.
I understand that Bible stories will be told at this event.
I know as a parent/guardian that I am responsible for any accidents or injuries that occur to my child(ren) before, during, or after Kid's Corner.
I understand that this event is for kids ages 5-11 years old.
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature
Submit
Submit
Should be Empty: