Kids Klub

Please use this form to register your child(ren) for Kids Klub

* Indicates required field

Parent/Guardian Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Alternate Phone Number *

Email *

Child 1 Name *

First

Last

Child 1 current grade level *

Child 1 allergies *

Child 2 Name *

First

Last

Child 2 current grade level *

Child 2 allergies *

Child 3 Name *

First

Last

Child 3 current grade level *

Child 3 allergies *

From time to time we may take pictures and/or video to capture the joy of Kids Klub. Is it ok to include your child(ren) in these? *

Yes No

Do we have your permission to share these pictures/videos on our church Social Media and/or website? *

Yes No

Please list any adult that will have your permission to pick your child(ren) up from Kids Klub. *

Anything additional you would like to share with our team *

Submit

If you are registering more than three children,
please submit an additional form.
Thank-you!