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HARRISON VALLEY ALLIANCE CHURCH
Please use this form to register your child(ren) for Kids Klub
*
Indicates required field
Parent/Guardian Name
*
First
Last
Person completing this form
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Phone Number
*
Best number to reach you at during Kids Klub hours
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!
Home
About
Prayer Requests
VBS