2021-22 KidZone Registration Form

Registration Form

Please fill out a new registration form for each student.
Student's Name: *

First Name Last Name
Birth Date: *

Month Day Year
Grade: *
What school do you attend? *
How will the child be arriving at KidZone? *
Is there a special friend or sibling that the child prefers to be grouped with?
Our home church is:
Parent/Guardian: *

First Name Last Name
Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone: *

Area Code Phone Number
E-mail: *
Emergency Contact (not parent / guardian): *

First Name Last Name
Emergency Contact Phone: *

Area Code Phone Number
Who is authorized to Pick up Child(ren) other than above listed parent - name and relationship: *
Special Needs / Alergies / Concerns:
Photography / Video Release:
I hearby give permission to First Presbyterian Church to photograph and / or videotape my child. The sole purpose of these photos and / or videos is for publication, advertisement, and exhibition of First Presbyterian Student Ministries.
Parental Consent

I consent to let my student participate in KidZone, Frontline, or Highlife. It is understood that every precaution will be taken for the safety and well-being of my child, but in the event of accident or sickness, First Presbyterian Church, its staff, and its volunteers are hereby released from any liability.
By signing this form, I give consent for my student (named above) to participate in First Presbyterian Church's Student Ministries.
Parent / Guardian Signature *

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