Vive Kids Check-in Registration

Parent/Guardian #1

Full Name

Cell Phone

This address will receive a confirmation email

Birthdate

Relationship to Child(ren)

Address Information (Child's Primary Residence)

Home Address

Does Parent/Guardian #1 live at the address above?

Yes No

List Parent/Guardian #1 as Emergency Contact? (at least one parent needed)

Yes No

Parent/Guardian #2

First & Last Name

Cell Phone

Birthdate

Relationship to Child(ren)

Does Parent/Guardian #2 live at the address above? Yes No N/A

List Parent/Guardian #2 as Emergency Contact? (at least one parent needed)

Yes No N/A

Pickup Authorization

List the full names and relationship (e.g., sister, aunt, grandfather, etc.) of other people authorized to pick up your child.

Individual Child's Information

First & Last Name (Child #1)

Birthdate

Gender

Male Female

Grade Level

School

Allergies / Medical Notes / Special Needs. If none, write N/A.

Please list any behavioral concerns or special needs that we should know about.

First & Last Name (Child #2)

Birthdate

Gender Male Female

Grade Level

School

Allergies / Medical Notes / Special Needs. If none, write N/A.

Please list any behavioral concerns or special needs that we should know about.

First & Last Name (Child #3)

Birthdate

Gender Male Female

Grade Level

School

Allergies / Medical Notes / Special Needs. If none, write N/A.

Please list any behavioral concerns or special needs that we should know about.

First & Last Name (Child #4)

Birthdate

Gender Male Female

Grade Level

School

Allergies / Medical Notes / Special Needs. If none, write N/A.

Please list any behavioral concerns or special needs that we should know about.

First & Last Name (Child #5)

Birthdate

Gender Male Female

Grade Level

School

Allergies / Medical Notes / Special Needs. If none, write N/A.

Please list any behavioral concerns or special needs that we should know about.

By registering my child(ren) for Vive Kids ministry, I authorize that my child's image or likeness may be photographed, filmed, and be used in video, print, or web materials, including Vive City Chapel's website and social media accounts.

By giving my email address and phone number, I understand that I will be added to Vive City Chapel's database. Vive City Chapel will not give or sell my personal information to any third parties.

Vive Kids Check-in Registration

Description

Please Fix the Following