Clearmont Community Church Kid's Club Registration

Clearmont Community Church Kid's Club Registration

Register your child for Kid’s Club (Wednesdays 4:00–5:45 PM), starting September 9, 2026—share required contact, medical, and transportation details.
Child's Full Name

First NameLast Name
Grade
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Parent/Guardian Full Name

First NameLast Name
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Email Address
example@example.com
Home/Mailing Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Emergency Contact Name
Emergency Contact Relationship
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Allergies, medications, medical conditions, or other information leaders should know
Transportation Choice
Home/Drop-off Address (if using church transportation)

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
I give permission for my child to receive basic first aid if needed.
I authorize emergency medical treatment for my child if necessary.
Do you give permission for your child to be included in group photos/videos? (No names will be used.)
Parent/Guardian Electronic Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty: