Kid Central: Yearly KidZone Medical/Registration Form • North Central Church

KidZone Registration & Medical

KidZone

KidZone is our twice-a-month (from September to the begining of June) gathering for kids age 4 through 6th grade. It is a family event, which means at least one adult per family must be present. All of our activities are family-oriented and adults are encouraged to participate!

A typical KidZone night starts off with an active game, followed by a review of what we have learned most recently in KidCentral and a small group discussion. Then we enjoy time doing a craft, and finish the night with another family game.

The vision of North Central Church is to see gospel transformation in every heart, home and neighborhood. KidZone is one way we try to reach the home component of our vision by creating a fun, Christ-centered environment for your family to connect with each other as well as other families.

There is 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

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 *

Your Signature (Please Type Your Name) *