Vive Kids Check-in Registration

Parent/Guardian #1

Full Name

Cell Phone

This address will receive a confirmation email

Birthdate

Relationship to Child(ren)

CHILD'S Primary Residence: Address Information

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.

Names of those authorized to pick up child(ren).

Individual Child's Information

First & Last Name (Child #1)

Birthdate

Gender

Male Female

Note: During the summer months (before August 3), please select the grade your child just completed.

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