WMBC Kid's Ministry Registration

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Please complete the following form to participate in our programs this year.

WMBC Kid's Ministry - Child Registration Form 2023-24

Child #1 Name:

Child # 1 Birthdate:

YYYY

Child # 1 Medical Number:

Child # 2 Name:

Child # 2 Birthdate:

YYYY

Child # 2: Medical Number:

Child # 3 Name:

Child # 3 Birthdate:

YYYY

Child # 3 Medical Number:

Parents names:

Contact number:

Contact email:

Alternative emergency contact:

Emergency Contact number:

Doctor name:

Doctor's phone #:

Mailing address:

Home address:

Current medications, Medication allergies, Food Allergies, Chronic/Mental Health Concerns (please name child that these apply to.)

Medical & Liability Waiver:
At WMBC, we take precautions to ensure the safety and health of your child, but in the event of accident or sickness, Waldheim Mennonite Brethren Church, its staff, and its volunteers are hereby released from any liability. In the event that your child requires special medication, x-rays or treatment, the parents/guardians will be notified immediately. By completing this form, I give permission for my child to participate fully in the activities and programs of the Waldheim Mennonite Brethren Church

Yes, I give permission

No, I do not give permission

Clear selection

Multi Media Waiver:
I understand that appropriate pictures are taken of various church activities and:

Yes, I give my permission to WMBC to use pictures/videos on any publication, advertising or web-site which contain images of my child.

No, I do NOT give my permission to WMBC to use pictures in any way.

Other:

Clear selection

Date:

YYYY

Parent Signature:

Submit

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