Registration for Tuesday Night Kids Group

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Basic Info

Child's Name

First

Last

Child's Gender

Child's Date of Birth

Grade

Please describe any allergies, medications, medical conditions, physical or behavioral challenges, or other concerns.

Parent/Guardian

Name

Phone

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Emergency Information

Alternate Contact Person (in case of emergency)

Emergency Phone Number

Relationship to Child

Legal Stuff

Photos/videos may be taken of my child for craft projects and in-church purposes.

Photos/videos may be taken for use on the church webpage and Facebook.

As a parent or legal guardian of the above child, I authorize a representative of Homewood Evangelical Free Church to consent to all medical treatment as deemed advisable in the opinion of the attending physician in the event of a medical emergency. I give permission for the above named child to participate in all Kids Group activities. I waive and release Homewood Evangelical Free Church and any of its staff and volunteers from any and all liability for injury or illness.

Signature (first and last name)

Signature Date

I agree

By typing my name and checking this box, I am signing this application electronically. I agree that my electronic signature is the legal equivalent of my manual signature on this application.