KFC Registration 2016-2017

It’s that time of year again! We will begin Kids For Christ on Wednesday September 14th. Dinner is served before class time from 5:30-6pm following that is class time from 6-7 pm. Your child (children) will learn about God in a class with their peers. Kids for Christ is for 4 years old through 12th. grade.

2016-2017 Kids For Christ Registration

Child's Name *

First

Last

What grade is your child in? *

Parents Name *

First

Last

Phone Number *

Is it okay to send text message *

Cell Phone *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Emergency Contact & Phone number *

Relationship to you? *

Facts concerning the child’s medical history, including allergies, medications being taken and any physical impairments to which a physician should be alerted. *

yes no

If Yes- List Allergies, Medications being take. *

Medical Authorization To Grant Consent

Physician & Phone number *

Dentist and phone number *

Preferred Local Hospital *

In the event reasonable attempts to contact me have been unsuccessful, I hereby give my consent for the administration of any treatment deemed necessary by the above name doctors, or, in the event the designated preferred practitioner is not available, by another licensed physician or dentist and the transfer of the child to any hospital reasonably accessible. This authorization does not cover major surgery unless the medical opinions of two other licensed physicians or dentists, concurring in the necessity for such surgery, are obtained prior to the performance of such surgery. *

Yes No Refusal to Consent

Church Bus Authorization

If you have a Risingsun or Bradner address the church bus would be able to pick up your child (children) if you live outside the Risingsun/Bradner area, Please contact us and we will evaluate bus transportation for you. Please contact us by email - fcogrisingsun@gmail.com or call 419-457-3971.

Do You need Transportation? *

Yes No

Bus pick up address *

Bus drop off address *

Is it okay to Text you if there is no transportation *

Yes No

Cell phone number to send text *

Submit

2016-2017 Kids For Christ Registration

Medical Authorization To Grant Consent

Church Bus Authorization

Please Note the new KFC dismissal pattern