Kingdom Kids Registration
One Registration Per Child
Child's First Name *
Your answer
Child's Last Name *
Your answer
Home Address *
Your answer
City and Zip Code *
Your answer
Birth Date *
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Grade (for 2019 - 2020) - Children must be potty trained to attend Kingdom Kids
Parent/Guardian (1) - First Name *
Your answer
Parent/Guardian (1) - Last Name *
Your answer
Primary Phone # *
Your answer
Secondary Phone #
Your answer
Email *
Your answer
May we add you to our e-mail list to update you about other things that is going on at Calvary Christian Reformed Church?
Parent/Guardian (2) - First Name
Your answer
Parent/Guardian (2) - Last Name
Your answer
Primary Phone #
Your answer
Secondary Phone #
Your answer
E-mail Address
Your answer
May we add you to our e-mail list to update you about other things that is going on at Calvary Christian Reformed Church?
Emergency contact (other than parent/guardian): *
Your answer
Emergency contact's Phone # *
Your answer
Child's Physician's Name
Your answer
Physician's Phone #
Your answer
My child has allergy/food allergy/health concerns? *
If yes, please explain.
Your answer
My child has special needs? *
If yes, please explain.
Your answer
My child has an EpiPen? *
If yes, please explain.
Your answer
In addition to yourself, who has authority to pick up your child/youth? (Give names and phone numbers)
Your answer
Other Comments
Your answer
By continuing with this registration, I consent to the following: (1) In the event my child has a medical emergency and I am unable to be reached, Calvary Christian Reformed Church's staff or volunteers may obtain medical treatment for my child. (2) Calvary Christian Reformed Church may use my child's photos, and video in promotional materials regarding the ministries of Calvary Christian Reformed Church. *
LIABILITY RELEASE
I, the undersigned parent or legal guardian for my child registered in this registration, release, forever discharge and agree to hold harmless Calvary Christian Reformed Church and all the representatives thereof 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 my child or youth in the course of participation in all the schedules and activities of Calvary Christian Reformed Church during 2019-2020. Those activities include the following, but are not limited to: youth group meetings, Kid's Club meetings, Cadet meetings, Gems meetings, Kingdom Kids meetings, field trips, camp outs, swimming, boating, hiking, sporting events, games, crafts, sport activities, and any other activities they may participate in. Further, I certify that my child is physically fit and adequately trained to participate in such events, including swimming (except as noted above). I agree that if for any reason my child needs to come home or be sent home, that I will come and get them. I give authorization for the church to provide all necessary food, transportation, and lodging (if applicable). I understand that I will be notified in the case of a medical emergency involving my child or youth. However, in the event that I cannot be reached, I authorize the contacting of a physician and the providing of all necessary medical services in the event my child is injured or becomes ill. I understand that Calvary Christian Reformed Church, its agents or representatives will not be responsible for any medical expenses incurred, but that such expenses shall be my responsibility as parent/guardian. I also release Calvary Christian Reformed Church and any and all of its agent from any and all liability should my child or youth incur an injury or illness. I agree to notify Calvary Christian Reformed Church’s office staff in the event of any health changes, which would restrict my child’s or youth’s participation in any normal child or youth activities. I also understand that the adult leaders reserve the right to restrict my child/youth from any activity that they do not feel is within the physical capabilities of my child/youth. [If applicable] should my child/youth registered in this registration have to return home before the meetings end, for medical or disciplinary reasons, I hereby assume any costs incurred.
Parent/Guardian Signature (By typing your name you are digitally signing and agreeing to the liability release) *
Your answer
Date *
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If you wish to give additional information, or to speak with the ministry leaders concerning any of the above, or wish to obtain any information concerning a specific event that your child or youth is obtaining permission to attend please call: Calvary Christian Reformed Church’s office staff: (616) 897-7060
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