PEFC - Kingdom Kids Registration Form

Kingdom Kids Registration Form

I am signing up my child for:

Parent/Guardian #1 First Name

Parent/Guardian #1 Last Name

Parent/Guardian #1 Phone Number

Email

Parent/Guardian #2 First Name

Parent/Guardian #2 Last Name

Parent/Guardian #2 Phone Number

Address 1

Address 2

City

State

Zip/Postal Code

Emergency Contact Info (if different)

Child(ren) Information: Please list you child(ren)'s name, age, birthday, and grade in school.

Allergies or other conditions that we should be aware of (food reactions, physical limitations, ADHD, ASD, etc.)

Kindgom Kids staff has permission to photograph/film my students for anything associated with the Kingdom Kids program, including the church website:
Yes
No

Signature of Parent or Guardian

I, the undersigned parent or guardian, do hereby authorize emergency medical, dental, health or hospital services be rendered to my child upon consent of a Princeton Evangelical Free Church staff member or designated volunteer. The purpose of this authorization is to permit my child to receive emergency medical attention when needed while involved in the activities connected with consent. This authorization shall be effective from September 2023 until August 2024. Typing you first and last name and today's date below will serve as your signature.

Kingdom Kids Registration Form

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