KiX Registration Form 2018-2019
Cost for KiX is $35 per child. Early bird discount (registration and payment complete prior to Sept. 09, 2018) is $30. Families with 3 or more children pay a maximum of $70. Please make checks payable to Peace Lutheran and note in memo line child/children names. Financial assistance is available upon request. Please fill out a separate registration form for each child. Thank you!
Child's Name *
Your answer
Birth Date *
MM
/
DD
/
YYYY
Grade in School in 2018 *
Your answer
Name of Parent(s) *
Your answer
Email Address *
Your answer
Cell Phone *
Your answer
Home/Mailing Address *
Your answer
Youth T-Shirt Size *
Allergies *
Your answer
Health Concerns/Special Instructions *
Your answer
I authorize my child to participate in all KiX related activities. *
My child's photo can be used on Peace's website and Facebook page. (Please note that photos of kids will be taken during KiX activities, but if you answer "no", the pics will not be used for promotional purposes.) *
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