2022-23 KidZone Registration Form

Registration Form

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

First NameLast Name
Birth Date:*

MonthDayYear
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 NameLast Name
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone:*

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

First NameLast Name
Emergency Contact Phone:*

Area CodePhone 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*

Clear
Should be Empty: