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k!dz life Registration Form

Registration form for k!dz life

Child's full name: *

Age: *

Grade: *

Birthdate: *

M/F: *

Allergies/Special Concerns: *

Parent's name: *

Address: *

Phone: *

Email:

In case of Emergency (If parents cannot be reached): *

Others authorized to pick up child:

Will your child need childcare from 7:30-8:00 pm?:

yes

no

Childcare is ONLY available for children who have siblings participating in the L.I.F.E. program. L.I.F.E. is on Wednesdays, 5:30-8:00 pm

I give my consent for my child to be photographed or taped for church purposes: * Initial for approval

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