Registration/ Permission Slip

Registration/ Permission Slip 2026/2027
- Child's Name
  
  First NameLast Name
- Today's Date
  
  MonthDayYear
  Date
- Address Of Pick Up/Drop Off
  
  Street Address
  
  Apt. No.
  
  CityState / Province
  
  Postal / Zip Code
- If your child needs a ride, do you give permission for your child to ride in our church van or receive a ride from a leader?
- LEADER CONTACT INFO: Pastor Tim Hood(804)397-9725 Renee French(607)760-7575
- Age Of Child
- Birth Date
  
  Date
- Grade For 26/27 School Year
- School
- PARENT/GUARDIAN NAME
  
  First NameLast Name
- Phone: Cell
  Please enter a valid phone number.Format: (000) 000-0000.
- Phone: Home
  Please enter a valid phone number.Format: (000) 000-0000.
- Please list any food allergies or other allergies. (As part of our program, KK serves weekly meals and snacks).
- MEDICIAL Does your child have any medical issues we should be aware of?
  
  Other
- Do you allow Calvary Baptist Church to post your child's photo or video on the church’s official Social Media platforms (e.g., Facebook, Instagram)?
- TO MINIMIZE BEHAVIORAL PROBLEMS CHILDREN WHO REQUIRE MEDICATIONS SHOULD TAKE THEM BEFORE ARRIVING AT KIDZ KAMP. (STAFF CANNOT GIVE MEDICATIONS).
- EMERGENCY CONTACT
  
  We must have an emergency contact number where we can reach YOU or someone desingnated by you (neighbor, relative, friend) in case there is an emergency during the time your child is in our care. THIS IS MANDATORY FOR ALL CHILDREN. If you do not give us an emergency contact, your child will not be allowed to attend.
- Emergency Contact Name
  
  First NameLast Name
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- PLEASE LIST BELOW WHO CANNOT PICK UP YOUR CHILD
- PICK UP AUTHORIZATION The following individual(s) are NOT allowed to pick up my child after club and escort him/her home.
- PARENT/GUARDIAN SIGNATURE
- Should be Empty:

Registration/ Permission Slip 2026/2027

LEADER CONTACT INFO: Pastor Tim Hood(804)397-9725 Renee French(607)760-7575

TO MINIMIZE BEHAVIORAL PROBLEMS CHILDREN WHO REQUIRE MEDICATIONS SHOULD TAKE THEM BEFORE ARRIVING AT KIDZ KAMP. (STAFF CANNOT GIVE MEDICATIONS).

PLEASE LIST BELOW WHO CANNOT PICK UP YOUR CHILD