Kids Ministry Registration

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Email *

Child's First and Last Name *

Gender *

Male

Female

Age *

Date of Birth *

YYYY

Grade *

Allergies/medical conditions we should be aware of? *

Mother/legal guardian's name (First & Last) *

Mother's phone number *

Mailing address *

Father/legal guardian's name (First & Last) *

Father's phone number *

Mailing address *

Emergency contact Name *

Emergency Contact phone number *

I give permission for Paradise Valley Church of God to use my child's picture for information, celebration, or promotion purposes in the church
*

Yes

Required

Purposes and Extent: The Paradise Valley Church of God is collecting and retaining this personal information for the purpose of enrolling your child in our programs, to assign the student to the appropriate classes, to develop and nurture ongoing relationships with you and your child, and to inform you of program updates and upcoming opportunities at our organization. This information will be maintained indefinitely as it is a requirement of our insurance company and legal counsel. If you wish for the Paradise Valley Church of God to limit the information collected, or to view your child’s information, please contact us.
*

YYYY

The safety of your Child is our primary concern. Precautions will be taken for their well-being and protection. I/we, the parents or guardians named below, authorize Erin Knoppers or one of Paradise Valley Church of God Ministry Personnel to sign a consent for medical treatment and to authorize any physician or hospital to provide medical assessment, treatment or procedures for your child. I/we, named below, undertake and agree to indemnify and hold harmless Program Personnel, Paradise Valley Church of God, and its leaders from and against any loss, damage or injury suffered by the participant as a result of being part of the activities of Paradise Valley Church of God, as well as of any medical treatment authorized by the supervising individuals representing Paradise Valley Church of God. This consent and authorization is effective only when participating in or traveling to events sponsored by Paradise Valley Church of God.
*

I agree

I disagree

Required

Your typed signature affirms that the information you have given is correct and that you have read and understood the information we have provided on this form.
*

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