KidMin Guest Form
WELCOME!  We are so exicted to see you on Sunday.  Please fill out the information below so that we are ready for you and your family. Thanks!
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Last Name *
Parents First Name *
Address *
Cell Phone # *
Home Phone #
Email *
1 Child's Name *
Allergies/ Medical Conditions *
Birthday *
MM
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DD
/
YYYY
School & Grade *
If your child has an IEP in school, please let us know any accommodations we can make that would be beneficial to them.
2 Child's Name
Allergies/ Medical Conditions
Birthday
MM
/
DD
/
YYYY
School & Grade
If your child has an IEP in school, please let us know any accommodations we can make that would be beneficial to them.
3 Child's Name
Allergies/ Medical Conditions
Birthday
MM
/
DD
/
YYYY
School & Grade
If your child has an IEP in school, please let us know any accommodations we can make that would be beneficial to them.
LIABILITY RELEASE Every activity sponsored by SCPC is carefully planned and adequately supervised by mature adults. However, even with the best of planning and precaution, unforeseen events can occur. By agreeing to this question, the parent or guardian agrees to assume and accept all risks and hazards inherent in church-related social activities. They also agree to hold SCPC, or its employees or volunteer assistants harmless for damages, losses, or injuries to the person or property undersigned. The parents or guardians understand that they are agreeing for the minor listed on this form and the signature is for both a medical and liability release. Our church’s insurance is excess insurance. If you have medical insurance, your carrier will be billed for medical charges in the case of illness or injury while your son or daughter is participating in a church-related activity.  In the event that I cannot be reached in an emergency during the dates specified on this form, I hereby give my permission to the physician or dentist selected by the church leadership to hospitalize, to secure proper treatment, and/or order an injection, anesthesia, or surgery for my son or daughter as deemed necessary. *
Required
MEDIA CONSENT I give my consent and permission for the taking of photographs and/or video of my child for 2021/2022 and waive and/or assign any and all rights (including copyright) in such media to SCPC for promotional use in print and online. SCPC will not use their full names with the picture of the students on their website, nor will it tag any children used on SCPC or Kids at the Creek facebook pages. *
Required
Date *
MM
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DD
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YYYY
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