Kidzone Registration

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

This class is for children ages 3 to Grade 6.

First and Last Name *

Age *

Birthday *

YYYY

Today's Date *

YYYY

Parents/Guardians *

Address *

City *

Postal Code *

Home Phone Number *

Cell Phone Number *

Parents/Guardians email address *

In case of need, adult to contact during Kidzone: *

Adult's Location (Service? Home?) *

Teachers usually provide the classes with snacks. Please list any allergies your child has to specific foods: *

Do you or your child carry any allergy or other medication? *

Yes

If yes, with whom is the medication kept?

Parent/Guardian

Child

Clear selection

Are there any health concerns or allergies (not related to food) of which teachers need to be aware? *

Is your child toilet trained? In keeping with Kidzone's child protection policies, you will be called if your child needs to be changed. *

Yes

Can your child handle him/herself independently in the washroom? *

Yes

Please list the people who have your permission to pick up your child when Kidzone is over. (Include yourself in the list) Your child is not to be released to anyone other than those you have listed here. *

There are times during the Kidzone year that situations arise when we would like to take pictures of the children participating in various activities. These pictures would be used within the church building only. They would not be used outside the church. (ie. on the church website, on promotional material use) *

I give permission for my child to be included in the photographs

I do not give my permission for my child to be included in the photographs

Name of person registering this child (First and Last) *

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

Forms