GMS Kids Kingdom
Registration Form
Student Name *
Your answer
Parent 1 Name *
Your answer
Parent 2 Name
Your answer
Home Address *
Your answer
Email Address 1
Your answer
Email Address 2 *
Your answer
Phone Number 1
Your answer
Phone Number 2 *
Your answer
Student's Age *
Date Signed *
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Does your child suffer from any allergies? *
Please specify your child's allergies
Your answer
In the course of Kids Kingdom events and activities, photographs and/ or video photographs may be taken by Teachers and or leaders.For use in promoting Kids kingdom. *
I completely understand and realize that participation in the activity and event hosted, sponsored, or promoted by Greater Mt. Sinai could include actions or tasks which might be dangerous or hazardous to me and my child. *
I agree to the fact that participation can cause any harm or injury to me and my child. I release Greater Mt. Sinai from all liability, costs and damages which could arise from participation in any activity and event hosted, sponsored, or promoted by Greater Mt. Sinai. I agree to accept financial responsibility for the costs related to any emergency treatment and give my confirmation of the same. *
Questions, Comments and Concerns
Your answer
Please type your name to confirm your review of this registration form and agreement to all terms and conditions herein. *
Your answer
Today's Date *
MM
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DD
/
YYYY
Present Time *
Time
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