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Kid City Registration 2018
Please use this form to register your child for Kid City.
If you have multiple children attending, please fill out a separate form for each of them.
Email address *
Child's name? (first and last) *
Your answer
Child's address? *
Your answer
Child's birthdate? *
Your answer
Child's age? *
Your answer
What grade will the child be in this fall? *
Mom's or Guardian's name? *
Your answer
Mom's or Guardian's phone? *
Your answer
Mom's or Guardian's email? *
Your answer
Dad's or Guardian's name? *
Your answer
Dad's or Guardian's phone? *
Your answer
Dad's or Guardian's email? *
Your answer
Emergency Contact's name? *
Your answer
Emergency Contact's phone? *
Your answer
Please list any allergies your child has, or any other needs we need to be aware of. If none, please put N/A. *
Your answer
May we use your child's photo and/or video image to share with Crossroads Church and to promote Kids City in the future via printed materials, the Crossroads website, and Crossroads social media platforms? *
Do you agree to come into the building each evening to both check in and pick up the children that you register? At check in, you will receive a parent receipt along with the children's name tags. Do you agree to provide the parent receipt or make sure the guardian picking up the children has the parent receipt or a picture of it to provide when picking up the children from Kid City. *
Kid City is run by Volunteers. We need YOU. How can YOU help? *
Required
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