Permission Form for Wednesday Kids 2026/2027
at Lakewood Christian Church, 3:30-5:00 pm (starting September 2)
Child 1 Name
*
First Name
Last Name
Child 1 Grade
*
Child 1 School
*
Child 2 Name
First Name
Last Name
Child 2 Grade
Child 2 School
Child 3 Name
First Name
Last Name
Child 3 Grade
Child 3 School
Child 4 Name
First Name
Last Name
Child 4 Grade
Child 4 School
Contact Parent's Name
*
First Name
Last Name
Contact Phone for text alerts
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Allergies/ health concerns. (please note which child)
I need my child to be picked up from the following school on Wednesdays
Will Rogers
Puterbaugh
Parker
Frink
Walk over from Lakewood
After Wednesday Kids at 5:00 pm...
*
I will pick up my child before 5:15 at the Lakewood School entrance
My Lakewood School student needs to go to extended care
I give my permission for my child's picture to be used on Facebook. (Follow our "Lakewood Kids" page)
*
Yes
No
Signature
*
Submit
Should be Empty: