Online Registration Closes at 6:00pm on Sunday, June 4th, 2023!Child's First Name *Child's Last NameChild's Date of Birth *Child's Class Grade for FALL of 2023 *Select GradeKindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade7th Grade8th GradeMust have completed KindergartenParent/Guardian First Name *Parent/Guardian Last NamePhone Number of Parent/Guardian *Email Address *Street Address *Apartment, suite, etcCityState/ProvinceZIP / Postal CodeParental/Guardian Authorization- The following people have permission to pick up my child:List Any Food AllergiesList Any Medical Concerns or Special InstructionsEmergency Contact First Name *Emergency Contact Last NameEmergency Contact Phone *Medical Release: I authorize Kingdom City Church to administer medical care should it become necessary, understanding that I will be contacted immediately in such an event. In the event that someone cannot be reached, I hereby authorize a church reprsentative to secure proper treatment necessary for my child named above. I accept responsibility for payment of expenses incurred as a result of medical treatment. *By checking this box, you consent to our Medical ReleaseMedia release: By attending this event I give Kingdom City Church permission to use my child's image on church Facebook page, church website, video and other media, knowing that all media is used form promotional purposes only. *By checking this box, you consent to our Media ReleaseLiability Release: I hereby release Kingdom City Church and all its participants from any liability or damage to or loss of personal property, sickness or injury from whatever source which might occur while attending this event. *By checking this box, you consent to our Liability ReleaseSignature *Start signing your signature hereYour browser does not support e-Signature field.Send Message
