2017 Kid Zone Registration

Child's Name

Grade

Teacher or Homeschool

Parent

Address

City, State, Zip

Phone

Alternate Phone

Email

Emergency Contact Name

Emergency Contact Phone

Allergies or Special Needs?

My child has permission to participate in all activities of KidZone at FUMC.

Representatives of FUMC have my permission to transport my child from school to the church and to related KidZone activities within the community.

I understand that I will need to contact the church by 11am if my child is unable to attend KidZone on any given Wednesday.

I understand that children must be picked up no later than 5pm from KidZone. Volunteers will be unable to supervise children after dismissal.

Representatives of FUMC have my permission to seek emergency medical treatment for my child at the nearest hospital. The staff of said hospital has my authorization to provide treatment deemed necessary for the well being of my child.

I agree to hold Grove FUMC and its representatives free of liability for any injuries, damages or loss unless caused by willful or intentional conduct on the part of the church or its representatives.

I give permission for photographs and videos taken of my child while participating in KidZone and or church related activities at FUMC to be used in church communications such as the newsletter, enews, facebook and the website.