Kidz Connection Registration Form

In order to provide a safe and secure environment for your child, we ask you complete this registration form. You must fill out one form per child. Alternatively, you can obtain a paper form at the church from the Kidz Connection table or the church office. This form is specifically for regular Kidz Connection weekly/regular events (Sunday School, Tuesday Nights) and is not for VBS or other special events.

This online registration form is a convenience feature and your supplied information will only be available for office use and authorized program workers only.

Family Information

Home Phone: *

Last Name: *

Mailing Address: *

City, Province: *

Postal Code: *

We Are: *

Visiting

Newcomers

Regular Attendees

Email: *

Custody Concerns: *

Yes

Are there any custody concerns we should be aware of that will help us protect your children?

If yes, please explain:

Parent/Guardian Information

The information provided on Parents and Guardians is required so that Kidz Connection team members know exactly who is permitted to pick up the child. ALL LEGAL PARENTS/GUARDIANS MUST BE NOTED!

PLEASE NOTE: If you only fill out ONE parent or guardian we will only release the child to THAT parent or guardian so PLEASE ensure you list them all!

Primary Parent/Guardian Information

The information below is required for the primary parent or guardian of the children.

Relationship: *

Your relationship with the children

Name: *

Cell: *

Work: (optional)

Additional Parent/Guardian Information

You may add another parent or guardian for the children.

Relationship:

Your relationship with the children

Name:

Cell:

Work: (optional)

Additional Parent/Guardian Information

You may add another parent or guardian for the children.

Relationship:

Your relationship with the children

Name:

Cell:

Work: (optional)

Child Information

Please fill out the below section(s) for your children aged 0 years through Grade 6.

Child Information

Last Name (if different from above):

First Name: *

Sex: *

Boy

Girl

Grade: * (2008-2009 school year)

Age: *

Birthdate: *

Allergies/Additional Info:

Please provide any additional information that the Kidz Connection team should be made aware of (such as allergies or other health concerns, etc.)

Additional Child Information

Last Name (if different from above):

First Name:

Sex:

Boy

Girl

Grade: (2008-2009 school year)

Age:

Birthdate:

Allergies/Additional Info:

Please provide any additional information that the Kidz Connection team should be made aware of (such as allergies or other health concerns, etc.)

Additional Child Information

Last Name (if different from above):

First Name:

Sex:

Boy

Girl

Grade: (2008-2009 school year)

Age:

Birthdate:

Allergies/Additional Info:

Please provide any additional information that the Kidz Connection team should be made aware of (such as allergies or other health concerns, etc.)

Additional Child Information

Last Name (if different from above):

First Name:

Sex:

Boy

Girl

Grade: (2008-2009 school year)

Age:

Birthdate:

Allergies/Additional Info:

Please provide any additional information that the Kidz Connection team should be made aware of (such as allergies or other health concerns, etc.)

Signature: *

Please type your full name to represent your signature and agreement.

This Week's Events

Monday:

No GenU Young Adults

Tuesday:

Christcity Prayer @ 7:00pm

No GenU Youth

Friday:

Youth: Corn Maze @ 6:30 - 9:45pm

Sunday:

Ministry Fair

Get upcoming event details

Kidz Connection Registration Form

Family Information

Parent/Guardian Information

Child Information

Consent

This Week's Events