Kids' Club 2019 | Online Registration

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Child

First Name

Last Name

Birth Date

Grade

Sex

Allergies

Custody Alert (give details)

The following people can pick up my child and will be asked to show photo ID:

Is there any other information that we should know about your child?

Emergency Contacts

Contact #1 name

Contact #1 phone

Contact #2 name

Contact #2 phone

Parent/Guardian

First Name

Last Name

Address (with postal code)

Home phone

Work phone

Mobile phone

Email address

Second Parent/Guardian

First Name

Last Name

Home phone

Work phone

Mobil phone

Email address

Consent

By submitting this form, you agree to the following:

I understand that I am responsible for ensuring my child is picked up from Kids Club promptly at 7:45pm.
I give permissing for my named child to participate fully in the St. Luke's Anglican Church Kids Club programs.
I give permission for my child's photo or video to be taken and understand that it could be used when promoting the St. Luke's Anglican Church Kids Club (no personal information will be used).