kidZONE Registration
Child's Name
Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Age
Grade
Parent/Guardian's Name
Address
City/State/Zip
Phone Number
Format: (000) 000-0000.
Email Address
example@example.com
Allergies (Food/Other)
Medical Concerns (Ex. Reactions to allergens, asthma, allergic to bee stings, etc.)
Transportation Consent
Please list the names of those you authorize to pick up your child/children. We will not release your child to anyone without your consent. (Relationship: grandparent, aunt, uncle, family friend, etc.)
Name
Relationship
Phone
Format: (000) 000-0000.
Name
Relationship
Phone
Format: (000) 000-0000.
Name
Relationship
Phone
Format: (000) 000-0000.
Photo Consent
Yes, I give permission to Harmony Children's Ministries to photograph my child. I understand it may be used on social media or on printed materials.
No, I do not give permission to Harmony Children's Ministries to photograph my child.
Signature
Parent/Guardian
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Preview PDF
Submit
Should be Empty: