Kid's Club/Youth Registration

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Kid's Club/Youth REGISTRATION

Father's Full Name:

Mailing Address

City

Postal Code:

Phone:

Mother's Full Name:

Mother's Phone Number

1st Child's Full Name

2nd Child's Full Name:

3rd Child's Full Name:

1st Child's Birthdate

2nd Child's Birthdate:

3rd Child's Birthdate:

1st Child's Health Card #:

2nd Child's Health Card #:

3rd Child's Health Card #:

Person Authorized to Pick Up Your Child/ren - First and Last Name

Relationship To Your Child(ren):

Phone Number:

Does your child(ren) have any allergies, requires epi-pen, special needs, that we should be aware of?

Yes

Please Specify

Photo Release (See Info Below)

Yes

Additional Information About Your Child Which Would Be Helpful:

IMPORTANT - Please Read:

If you are not comfortable with entering your child's health card number above, please bring it with you on the first evening of club to be recorded in our records.

As part of the registration process, we ask that you carefully read the “Release” statements below.

MEDICAL RELEASE

As the legal parent or guardian of the above mentioned child(ren) I do herewith authorize treatment under the direction of any licensed physician of the above minor in the event of a medical emergency which, in the opinion of the attending physician, may endanger his or her life, cause disfigurement, physical impairment or undue discomfort if delayed. This authority is granted only after a reasonable effort has been made to reach me by phone at the number listed above. The undersigned assumes the responsibility for any costs connected with such treatment and hereby releases the Royal City Baptist Church where my child attends Kids Club/Vacation Bible School from any liability therefore. The release form is completed and signed of my own free will with the sole purpose of authorizing medical treatment under emergency circumstances in my absence. Registering your child on-line will be considered as consent and agreement to the above, unless otherwise indicated.

PHOTOGRAPHY RELEASE

During our club events, we take video and/or pictures of the children participating in the various club related activities. These are occasionally used to promote the church and club programs, to display on club bulletin boards, for presentations, slideshows, brochures etc… If your child is in these any of these photos do we have consent to use them as indicated? (yes/no button above)

Please provide any additional information that you feel will enable us to better serve your child in the Additional Information description box above! Should you have any questions, concerns or comments please let us know.

Thank you for registering in our Children’s Ministries at Royal City Baptist Church