Kidz Information Form

Kidz Information

Please help us to stay in contact and have all safety precautions in place for your child while we are able to hang out with them weekly. This form will serve as their info and permission form through May 2024!

Kidz First Name

Kidz Last Name

Birthday

Additional Kidz First Name

Additional Kidz Last Name

Birthday

Additional Kidz First Name

Additional Kidz Last Name

Birthday

Additional Kidz First Name

Additional Kidz Last Name

Birthday

Parent/Guardian 1 First Name

Parent/Guardian 1 Last Name

Parent/Guardian 2 First Name

Parent/Guardian 2 Last Name

Parent Email

Phone

Address

City

State

Zip/Postal Code

Family Insurance Company

Policy #

Family Physician

Phone Number

Please list any allergies or put N/A

Other medical conditions or medications that we need to be aware of? (Put N/A if none)

Emergency Contact First Name

Emergency Contact Last Name

Emergency Contact Phone Number

Do you give permission to your child/children above to participate in and to be transported to and from all activities, events, or trips sponsored by the Kidz or Student ministries of ELBERTON CHRISTIAN CHURCH during 2022 & 2023?
Yes

Do you acknowledge that you release and discharge ELBERTON CHRISTIAN CHURCH and its employees/volunteers from any and all claims, demands, actions, or cause of actions, past, present, or future arising out of injury or damage to your child/children or property of your child/children while participating in any activity, event, or trip associated with the church?
Yes

Do you give permission for your child/children to be recorded or photographed and their likeness may to used in video presentations, publications, and promotions, on our website and social media websites or in any other lawful manner?
Yes
No

Anything else you'd like to share?

Send