Waterloo First Kidz Ministry Registration
First Name *
Your answer
Last Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Grade *
School *
Your answer
Teacher *
Your answer
Address *
Your answer
Parent/Guardian *
Your answer
Email Address
Your answer
Home Phone *
Your answer
Cell Phone
Your answer
Emergency Contact 1 (Other than listed above) *
Name & Phone Number
Your answer
Emergency Contact 2 (Other than listed above)
Name & Phone Number
Your answer
Allergies *
If so what allergies?
Your answer
Special Medical needs
Your answer
May we have permission to photograph/video your child for promotional purposes? *
Does your Child need transportation to Activities? *
Do we have your permission to transport your child for Waterloo First Activities? *
As parent, or legal guardian, you remain fully responsible for any legal responsibility, which may result from any personal actions taken by the named individual.
Parent Signature *
Typing your name here will serve as your signature
Your answer
Date of Signature *
MM
/
DD
/
YYYY
Submit
Never submit passwords through Google Forms.
This form was created inside of First Baptist Church of Waterloo. Report Abuse - Terms of Service