Manna Monday Kids Club Registration & Release Form

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Welcome to Manna Monday Kids Club! ☀️🎨🍿

We are excited to offer a FREE summer program for children ages 5–16 every Monday from June 22 – August 3, 2026 from 11:00 AM – 1:00 PM.

Children will enjoy movies, reading time, arts & crafts, games, activities, and lunch each week in a safe and welcoming environment.

IMPORTANT:

-Parent/guardian registration and approval are REQUIRED before any child may participate.

-A completed release form and emergency contact information must be on file for every child.

-Parents are not required to stay during the program.

-Children must be picked up promptly at 1:00 PM unless written walking permission is provided.

-This is a supervised community enrichment program and not a daycare or childcare service.

-Manna Cafe Ministries reserves the right to dismiss participants for unsafe, violent, disruptive, or inappropriate behavior.

Please complete ONE form per child.

If you have questions, please contact:
(Zoie Linton/253-778-1111/zoie@mannacafeministries.com)

CHILD INFORMATION

1. Child’s Full Name *

2. Child’s Date of Birth *

YYYY

3. Child’s Gender (Optional)

Male

Female

Prefer not to say

Clear selection

4. Which Mondays will your child attend? *

June 22

June 29

July 6

July 13

July 20

July 27

August 3

Required

PARENT/GUARDIAN INFORMATION

5. Parent/Guardian Full Name

6. Relationship to Child

7. Parent/Guardian Phone Number

8. Parent/Guardian Email Address

9. Home Address

EMERGENCY CONTACT INFORMATION

If the emergency contact is the same as the parent/guardian listed above, please enter “Same.”

10. Emergency Contact Full Name *

11. Emergency Contact Relationship to Child *

12. Emergency Contact Phone Number
*

AUTHORIZED PICKUP INFORMATION

Please include names and phone numbers of all authorized pickup individuals.

13. Who is authorized to pick up your child? *

14. Is your child allowed to sign themselves out or walk home? *

Yes

MEDICAL INFORMATION

15. Does your child have any allergies? *

Yes

16. If yes, please list all allergies and any necessary instructions.

17. Does your child have any medical conditions, medications, or special needs we should be aware of?

18. I understand that Manna Cafe Ministries staff and volunteers will not administer medications. In the event of a medical emergency, emergency services (911) may be contacted. *

Yes

Required

PHOTO/MEDIA RELEASE

19. Do you give permission for your child to be photographed or video recorded during activities for use on social media, promotional materials, websites, newsletters, or ministry-related publications? *

Yes

LIABILITY WAIVER

20. Please check the box below to acknowledge agreement with the following: *

I understand that my child is participating in a free community summer program hosted by Manna Cafe Ministries. I acknowledge that while reasonable supervision will be provided, participation includes normal risks associated with group activities. I release and hold harmless Manna Cafe Ministries, its staff, volunteers, and partners from liability for minor injuries, accidents, lost belongings, or incidents that may occur during participation, except in cases of gross negligence. I certify that my child is physically able to participate in program activities.

Required

PROGRAM POLICIES

21. Please check the box below to acknowledge agreement with the following: *

I understand that:

Parent/guardian registration is required before participation.

Children must be picked up promptly at 1:00 PM unless walking permission is provided.

This is not a daycare or childcare service.

Manna Cafe Ministries reserves the right to dismiss participants for unsafe, violent, disruptive, or inappropriate behavior.

In the event of an emergency, staff may contact 911 and/or emergency contacts listed above.

Required

FINAL SIGNATURE

By typing your full name below, you agree that this serves as your electronic signature.

22. Parent/Guardian Electronic Signature *

Submit

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