Libby Christian Church 10:14 KIDS 2017 Registration ~ (kids k - 4th grade)
10:14 KIDS is sponsored by Libby Christian Church and is held at the Asa Wood school. It meets every Wednesday paralleling the school calendar from September 27, 2017 - April 2018. We would love your child to be part of this action-packed after-school program for kids in K-4th grade that includes sports, arts, Bible learning, snacks and much more!

Transportation by Libby Christian Church from the schools is available with parental consent (you will be able to give your consent in the form below).

Child's First Name: *
Your answer
Child's Last Name *
Your answer
Family Email: *
Your answer
Child's Gender: *
Required
School Grade: *
Your answer
Child's Age: *
Your answer
Date of Birth: *
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Name of parent or legal guardian *
Your answer
Mailing address: *
Your answer
Preferred phone: *
Your answer
Emergency Contact: (Name and Phone) *
Your answer
Medical Information:(Medical concerns, allergies or other information we need to know about) *
Your answer
Authorize Consent: In the event my child is injured or becomes ill in program activities, and if I, the parent or guardian of the above-named child, am not present to make medical decisions, I hereby authorize the Church, its staff, volunteers including volunteer parent participants, and drivers, to arrange for and consent on my behalf to emergency medical treatment, including tests and radiological exams, and surgery, and hospital care and treatment, and to consent to medications for pain and other conditions as prescribed by medical personnel attending my child. I am responsible for payment of any medical charges or expenses not covered by my insurance or the insurance applicable to my child. This applies only in the event that neither parent/guardian can be reached in case of an accident during activities related to the church. *
Required
I give permission for my child to ride the Libby Christian Church bus from school to Asa Wood. I will pick my child up promptly at 4:30 from Asa Wood after 10:14 KIDS. *
Required
I give permission for my child's picture to be taken at church sponsored events for publicity purposes and possibly be posted on the internet. *
Required
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