KFC Registration 2021-2022

Kids For Christ will begin Wednesday, September 29, 2021
Wednesday's 5:30-7pm Kids 4 years old through 12th Grade.
Staff & students enjoy dinner at 5:30-6pm. Class time begins at 6pm where students discover God’s truths in the Bible and how they can apply it in their own lives.

2021-2022 Kids For Christ Registration

* Indicates required field

Child's Name *

First

Last

Grade *

Parents Name *

First

Last

Phone Number *

Is this a cell Phone ? *

Yes No

Is it okay to send text message *

Address *

PO BOX *

City *

Zip code *

Email *

Emergency Contact & Phone # and Relationship to the child *

Are there any 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

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 - [email protected] or call 419-457-3971.

Do You need Transportation? *

Yes No

Bus pick up address *

Bus drop off address *

If you do not need transportation will you be picking up your child using the drive thru pick up, or will you be coming in to pick up *

My child has permission to ride the church bus provided by the First Church of God. In the unlikely event of an emergency, I give permission for my child to receive treatment by a licensed physician in an approved emergency room or clinic. I further release from liablilty the First Church of God and the staff members, bus drivers and helpers in case of any accident en route to and from Kids For Christ. Please type in Parent or Guardain's name. *

Check yes or no *

Questions or comments? *

Submit

2021-2022 Kids For Christ Registration

Medical Authorization To Grant Consent

Church Bus Authorization

Please Note the new KFC dismissal pattern