NowKids Club Registration 2019/20
Sign in to Google to save your progress. Learn more
First Name *
Last Name *
Grade *
Birthdate *
MM
/
DD
/
YYYY
School Attending
Name of Parent/Guardian *
Address
Parent Email *
Parent Cell Phone # *
Church your family attends - if applicable
Child's Physician
Physician's Phone #
Food Allergies? *
Other Dietary Restrictions?
Are any medications being taken?
Are there any medical, or other, concerns of which we should be aware?
Child's Special Interests/Fears
If your child becomes ill, who should we contact first? Please include phone #. *
If this person cannot be reached, who else may we contact? Please include phone #'s. *
Name of Insurance, Name of Policy Holder, ID #, and Phone # *
Photo Consent                                                            I do hereby grant permission to Indian Valley Faith Fellowship for the use of photograph(s) or electronic media images of my minor child/ren of any kind, in any presentation, including but not limited to live streaming and recording of services and events, social media pages and marketing materials. I understand that I may revoke this authorization at any time by notifying the IVFF office in writing. The revocation will not affect any actions taken before the receipt of this written notification. *
Required
By checking the box below I hereby release Indian Valley Faith Fellowship Church, its personnel, volunteers and employees,  from any and all liability, responsibility, claims or actions of every kind, including but not limited to property damage, public liability, or personal injury as a result of any Kid's Club activity in which my child is involved.  Furthermore, I/we hereby grant our/my permission for said participant to participate fully in all activities and hereby authorize medical treatment, including but not limited to emergency surgery or treatment, and I/we assume full responsibility of all medical costs, if any. *
Required
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms