Kidz Church Registration Form

Parent/Guardian
Name

First NameLast Name
Spouse's Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian's Cell Phone Number
Please enter a valid phone number.
Spouse's Cell Phone Number
Please enter a valid phone number.
CHILD #1
Child's Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Age*
Age Group*
3. Any Allergies, Medical conditions, Behavioral Issues, or learning disabilities?
CHILD #2
Child's Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Age
Age Group
3. Any Allergies, Medical conditions, Behavioral Issues, or learning disabilities?
CHILD #3
Child's Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Age
Age Group
3. Any Allergies, Medical conditions, Behavioral Issues, or learning disabilities?
CHILD #4
Child's Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Age
Age Group
3. Any Allergies, Medical conditions, Behavioral Issues, or learning disabilities?
CHILD #5
Child's Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Age
Age Group
3. Any Allergies, Medical conditions, Behavioral Issues, or learning disabilities?
Emergency Contact Cell Phone Number*
This is the number we will text if we need to you to come down while your child is in Kidz Church.
WAIVER OF LIABILITY & MEDICAL RELEASE

I understand that while SonRise Bible church will take reasonable precautions, our children’s ministry program involves the possibility of unforeseeable risks. In exchange for the Church allowing your child(ren) to participate in our Children’s program (SonRise Kids), I waive and I release and discharge SonRise Bible Church, their related ministries and organizations, and each of its elders, directors, officers, managers, employees, volunteers, members, and agents from any and all claims, losses, or expenses arising from or related to SonRise Bible Church’s children’s ministry activities. I also agree to indemnify, hold harmless, and defend the church and each of the other parties listed above with regard to such cliams, losses, or expenses, including without limitation any claims made by or on behalf of the participant.

I HAVE READ AND FULLY UNDERSTAND THIS FORM. I UNDERSTAND THAT I AM WAIVING AND RELEASING ANY CLAIMS. By registering your child, you give us permission to use photos or videos captured by our staff that may included your child for use by SonRise Bible Church.

Parent or Guardian sign below. I understand and agree to be bound by this Authorization and Waiver and sign it both in my capacity as parent or guardian and in a representative capacity on behalf of my child(ren).
Signing Parent*

First NameLast Name
Signature Date*

MonthDayYear
Date
Parent/Guardian Signature*

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Parent/Guardian

CHILD #1

CHILD #2

CHILD #3

CHILD #4

CHILD #5

WAIVER OF LIABILITY & MEDICAL RELEASE