Kidz Club 2024

Kidz Club Registration

Kidz Club Dates: Every Tuesday starting October 8 and ending November 12

Child's First Name *

Child's Last Name *

School Grade *

Date of Birth *

Name of Parent(s) or Guardian(s) *

Home Address

Home City

Mobile Number *

Alternate Number

Emergency Contact and Relationship to Student *

Mobile Number for Emergency Contact *

Food Allergies *

Yes

If yes, please explain

Medical Concerns *

Yes

If yes, please explain

Family Doctor and Phone Number

Person(s) Name(s) Who May Pick up the Child

Kidz Club leaders have permission to photograph/film the minor(s) designated above for any lawful purpose associated with this Kidz Club program.

Thank you for giving us the opportunity to teach your child(ren) more about God and give them the opportunity to have fun at the same time that they learn!

Parent Signature

Date Signed

Choose Event

There are currently no events available for registration.