MEGA KID'S CLUB CHILD REGISTRATION

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February 20, 10 am - 2 pm Zion Fellowship (5188 Bristol Rd Canandaigua, NY 14424)
As a continuation of our Mega Sports Camp this event is open to all kids in our community grades K-5th to come on a day off and have a time of fun with one another. We will have games, activities, crafts, music, pizza and some fun in the snow (if we have some)!

Email *

Name of child *

Guardian(s) Name *

Address

1234 Street Name, Town, NY 12345

Phone (1) *

Phone (2)

Emergency Contact Name *

Emergency Contact Phone *

Are you connected to a church? If so, which church? *

Child's Grade *

Put down the grade your child will be entering in the fall

Gender of Child

Special Medical Needs

Please let us know of anything medically we should be aware of as a staff.

Dietary restrictions

Individuals Authorized for Pick-up *

Medical Authorization & Liability Release *

In consideration of our (my) child’s participation in Mega Kid's Snow Day as hosted by Zion Fellowship on 2/20/2023 We/I, for ourselves (myself) and on behalf of the minor child, do hereby assume all risk and release, forever discharge and agree to hold harmless Zion Fellowship, its staff and volunteer of from any and all liability, claims, or demands for personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned or child while participating in Mega Snow Day . We/I understand recreation activities and other physical activity will be part of the event. We/I are the parents(s) or legal guardian(s) of this child, and hereby grant our (my) permission for him/her to participate fully in said activities, and hereby give our (my) permission to take the child to a doctor or hospital in the event of an emergency and hereby authorize treatment, and we assume the responsibility of all medical bills, if any.

Yes, I have read and agree to the Medical Authorization & Liability Release

Signature of Guardian(s) *

Please type your name as a "digital signature" formally indicating you agree and approve all of the responses above as true and accurate.

Date of Signature

YYYY

Any last questions?

A copy of your responses will be emailed to the address you provided.

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