Yearly KidZone Medical/Registration Form • North Central Church

KidZone Registration & Medical

KidZone

KidZone meets the 1st or 2nd Wednesday of every month. Classes are designed for boys and girls ages 4 through 6th grade. There is a secure check-in process and screened teachers who will lead your children in fun activities while teaching them to treasure Jesus!

There is nursery available for children age 3 and younger and youth ministry for 7-12th graders.

Child Information

First Name *

Last Name *

School Grade *

Date of Birth *

Home Address *

Home City *

Home State *

Home Zip Code *

Please list any allergies, pertinent medical information OR special needs along with the name of the child they are associated with:

Allergies

T-Shirt Details

T-Shirt? Price is $10 *

Yes

PLEASE NOTE: After submitting the form, you will be asked to click the link to our online giving to purchase the t-shirt(s). Please select "KidZone T-Shirts" and pay $10 per shirt. You can also pay with cash/check at the time of picking up the t-shirt(s).

If purchasing a T-Shirt for this child, please select what shirt size

The child listed has my permission to participate in all Kid Zone activities associated with North Central Church.

I understand that North Central Church and their sanctioned members are not liable in case of accident. I understand that every precaution will be taken to provide a safe and secure environment for my child. I assume all risks associated with the activities inherent to those environments.

In the event I cannot be reached to make arrangements for emergency medical care at the time of illness or accident, I hereby authorize North Central Church to take my child to the nearest hospital with emergency care for my authorized treatment.

I have read and agree to the above information *

I agree

Name of Parent/Guardian

First & Last Name *

Address

Home Address

Tip: If different address than child

Home City

Home State

Home Zip Code

Contact Information

Mobile Number *

Phone Number

Email Address *

Emergency Contact Name *

Tip: other than Parent/Guardian listed above

Emergency Contact Number *

Tip: other than Parent/Guardian listed above

Additional Questions

Please subscribe me to your North Central Newsletter *

Yes Please!

No Thanks

I'm already Subscribed

Photo Release *

I'm interested in volunteering for KidZone. No need to be skilled in any area, we encourage our parents to be involved with their kids while they're learning gospel truths. *

Yes, please contact me.

No, not at this time.

Your Signature (Please Type Your Name) *