Kids Zone Registration Form
2026/2027
Child Details:
Full Name
*
First Name
Last Name
Birthdate:
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Age:
*
Please Select
2
3
4
5
6
7
8
9
10
11
12
Grade:
*
Please Select
PreK
Kindergarten
1
2
3
4
5
6
Allergies/Medical Conditions:
*
Does your child require any extra assistance:
*
On occasion, your child's teacher may want to take the children out to find things that God has created, or to go play at the school playground as a special treat. Please indicate if you give consent.
*
Yes
No
As part of the Children's Ministry Program, we may take pictures of your child. Please indicate if you give consent for their picture to be used in any of the following: Classroom, In the Church (PowerPoint or print) or on the Internet (Website, Facebook or Instagram)
*
Yes
No
Which service do you attend
Saturday 6:00pm
Sunday 9:00am
Sunday 11:00am
Parent/Guardian Details:
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
Province
Postal Code
Phone Number
*
Format: (000) 000-0000.
E-mail
Emergency contact (not a parent)
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship to child
*
Please Select
Grandparent
Relative (aunt or uncle)
Family friend
Other
Signature
*
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Continue
Continue
Should be Empty: