Kids Groups Registration 2022-2023

Child's Information

Name

If different from above, enter the name you wish to have your child addressed by their leaders below:

Nickname

Gender

Male Female

Address

Birthdate

Enter grade below for the 2022/23 school year:

Grade

School Other (if your school wasn't listed)

Parent/Guardian Information

Parent/Guardian Name(s)

Relation to Child

Parent e-mail

This address will receive a confirmation email

Please enter your phone numbers below with dashes, ex. 000-000-0000

Phone

Mom's Cell

Dad's Cell

What mobile number can we use to text you if your child needs you during Kids Groups?

Emergency Contact (if Parents/Guardians are not available)

Emergency Contact

Emergency Contact Relation to Child

Emergency Contact Phone

Authorization & Medical Consent

Does your child have any health concerns or allergies?

No, my child has no health concerns or allergies Yes, my child has health concerns or allergies

If you answered yes, please specify below:

Heath Concerns / Allergies

Medical Consent

I agree Please contact me regarding this

We (parent/guardian) allow WMBC Ministry staff and volunteers to provide medical needs (ex. apply a bandaid, call medical help if needed) when your child is in our care AND the parent/guardian is not available.

Communications

I give permission for videos and photos of my child to be used in WMBC for the website, newsletters, digital announcement, social media, and other promotional material. I agree they can be viewed by anyone but no identifying information will be displayed without consent.

Video/Photo Release

Would you like to receive email updates from Family Ministries Staff and/or your child's Small Group Leader?

Email Consent

Yes No

Purpose and Extent

WMBC is collecting and retaining this info in order to enroll your child in our programs, assign your child to appropriate small groups, and to inform you of updates or upcoming opportunities at WMBC. If you wish to limit the information please contact us.

I have read, understood, and agree with the above and sign it to cover all children's program activities for the program year effective as stated below. A separate Informed Letter of Consent will be sent home for off-site activities and activities of elevated risk.

By entering my name, I am indicating my acceptance and delivery of this information.

Consent Date

How often are you willing to serve as a helper for this child's group in Kids Groups?

Once a month Once every other month Once in the ministry year Other

If you chose 'other' please specify

Kids Groups Registration 2022-2023

Description

Please Fix the Following