Kidz Clubz 2018-2019
Kidz Clubz 2018-2019
Parent's Names:  * 
Address:  * 
City, State, Zip:  * 
Primary Telephone:  * 
Emergency Contact and Telephone:  * 
Who is authorized to pick up your child?  * 
Child 1-Name:  * 
Child 1 - Age and Birthday:  * 
Child 1 - School & Grade:  * 
Child 1 - Gender:  * 
Does Child 1 Have Any Allergies or Health Issues? If so, please list:  * 
Child 2 - Name:  * 
Child 2 - Age and Birthday:  * 
Child 2 - School & Grade:  * 
Child 2 - Gender:  * 
Does Child 2 Have Any Allergies or Health Issues? If so, please list:  * 
Child 3 - Name:  * 
Child 3 - Age and Birthday:  * 
Child 3 - School & Grade:  * 
Child 3 - Gender:  * 
Does Child 3 Have Any Allergies or Health Issues? If so, please list  * 
Please Select Number of Children Registering:
I give my permission for the use of any photo or likeness of my child to be used by the CrossLife Church for their use in promotional materials.
MEDICAL & LIABILITY RELEASE - We realize that no activity is without the possibility of unforeseen hazards which could result in injury to an individual.
As a parent or guardian, you are to be aware of your responsibility to instruct your child of the importance of conduct which will insure safety and an enjoyable time for all.
By signing this form, you, as a parent, guardian or other responsible party, agree to assume the risks and hazards which are inherent in this kind of activity.
You also agree to absolve and hold harmless the CrossLife Church and their representatives for damage, loss or injuries to the child for whom you sign.
In addition, by signing this form I give my child permission to participate in this activity.
I also give my permission to the leaders of this function to authorize any treatment deemed necessary by a licensed physician due to accident or illness during this activity.
Your Email Address  * 
Total $
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