Kid Zone Child Registration

Child Name

Nickname/Preferred Name

Date of Birth

Age

Grade

Gender

Male Female

Parent/Guardian 1

Parent/Guardian

Phone

Address

Relationship to child

Are you a member of Impact Church of Hope? Yes No First-time guest

Parent/Guardian 2

Parent/Guardian

Phone

Address (if different)

Relationship to child

Are you a member of Impact Church of Hope?

Yes No First-time visitor

Emergency Contact (if different from above)

Emergency Contact

Phone

Relationship to child

Medical Information

Does your child have any allergies?

If yes, please list

Medical conditions/special needs

Authorized Pick Up

Who is authorized to pick up your child?

Photo & Media Release

I give permission for my child to be photographed or recorded during church activities for ministry purposes (social media, website, promotional materials).

Yes No

Parent/Guardian Acknowledgement

I understand that my child is participating in activities at Impact Church of Hope and that reasonable care and supervision will be provided. I authorize church staff and approved volunteers to care for my child and to seek medical attention in the event of an emergency if I cannot be reached. I have disclosed all relevant medical and safety information. I agree to follow all check-in and check-out procedures and release Impact Church of Hope, its leadership, staff, and volunteers from liability except in cases of gross negligence or willful misconduct.

I have read and understand the acknowledgement section

Kid Zone Child Registration

Description

Please Fix the Following