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KidsRidge Registration
Contact us at (780) 875-8929 or
josiah@southridge.co
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* Indicates required question
Name of Child
*
Your answer
Birthday/Grade
*
Your answer
Name(s) of Parent/Guardian
*
Your answer
Email
*
Your answer
Contact Numbers of Parent/Guardian
*
Your answer
Does your child have any Allergies/Medical Conditions/Medications/Special Needs that we should know about?
*
Your answer
Family Doctor
*
Your answer
Health Number
*
Your answer
Emergency Contact (if parents/guardians are not available)
*
Your answer
I give permission for my child to participate in onsite activities as a part of the Southridge KidsRidge program. I give permission in the event of an emergency for transportation and medical treatment if required.
*
Yes
No
I give permission for photos to be taken of my child for use within Southridge KidsRidge activities and/or to be posted on the Southridge KidsRidge page.
*
Yes
No
By typing my name in the box below, I give signed consent for my child to participate in Southridge Youth.
*
Your answer
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