KING'S KIDS ENROLLMENT FORM

Be sure to include every child participating in our King's Kids programs on the form. Thank you so much.

Date:

Info of Mother/Guardian 1:

Name:

Cell #:

Address

Info of Father/Guardian 2:

Name:

Cell #:

Address (skip if same as above)

Children's Info:

Name of Child:

Date of Birth:

Age:

Does your child have any allergies? If so, please list them below.

Are there any health concerns or physical limitations that we need to be aware of? And how can we better suit their needs?

Second Child:

Name of Second Child:

Date of Birth:

Age:

Any allergies?

Are there any health concerns or physical limitations?

Third Child:

Name of Third Child:

Date of Birth:

Age:

Any allergies?

Are there any health concerns or physical limitations?

Fourth Child:

Name of Fourth Child:

Date of Birth:

Age:

Any allergies?

Are there any health conerns or physical limitations?

Pickup & Guardianship Info

What individuals have permission to pick up your child(ren) from class?

Are there any custody/legal issues we need to be aware of?

Health and Medical Info

Who do we contact in case of an emergency?

Emergency Contact #:

Photo Permission

Does King's Chapel staff have permission to take your child(ren)'s photo/video for promotional purposes? (website, social media, announcements, etc)?

Yes No

Final Contact Info

Email to send confirmation

This address will receive a confirmation email

Phone # to text during service if we need to contact you:

Description

Please fill out this form and click submit.

KING'S KIDS ENROLLMENT FORM

Description

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