Kidventure Registration Form

Child's Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Home/Cell Phone*
(###) ###-####
Age*
Date of Birth*
MM/DD/YYYY
MM slash DD slash YYYY
Grade*
Email*
Emergency Contact Name*
First Last
Emergency Contact Phone*
(###) ###-####
Allergies or other medical conditions:
Home Church
During Kidventure photographs may be taken to record all the fun. These photographs may be included in the church newsletter or on the website. Do you give permission for your child to be photographed?*
- Yes
- No
By checking this box, I give permission for my child to attend Kidventure sponsored by the First Presbyterian Church and First Baptist Church. I understand that in the unlikely event of an accident or illness, every effort will be make to contact me at the phone numbers given above. In the event I cannot be reached, I hereby authorize the adult leaders of First Presbyterian Church to take whatever medical attention deemed necessary, including securing the opinion and service of a physician or hospitalization.*
- Yes
- No
Name of Parent/Guardian*
First Last
Today's Date*
MM/DD/YYYY
MM slash DD slash YYYY
Name
This field is for validation purposes and should be left unchanged.

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