LK Ministry Registration, 2022

Parent/Guardian Information

We want to stay connected with your family!

Primary Parent/Guardian Name

Primary Phone

Primary Email

This address will receive a confirmation email

Would you like to receive the Lakewood Kids Family News by email twice a month?

Yes No

Primary Address

Secondary Parent/Guardian

Secondary Phone

Secondary Email

Secondary Address

Child Information

We need accurate information about your kids!

Child #1

Child's Name

Gender

Male Female

Birthdate

Grade (as of Sept 1, 2022)

School my child attends:

Lakewood Kids Classes my child will usually attend (choose all that apply):

Sunday morning, 9:00 AM Sunday morning, 10:45 AM Tapestry - Tuesday morning Clubhouse - Wednesday evening

The most important thing to know about this child is:

My child has the following food allergies or other medical concerns:

Child #2

Child's Name

Gender Male Female

Birthdate

Grade (as of Sept 1, 2022)

School my child attends:

Lakewood Kids Classes my child will usually attend (choose all that apply): Sunday morning, 9:00 AM Sunday morning, 10:45 AM Tapestry - Tuesday morning Clubhouse - Wednesday evening

The most important thing to know about this child is:

My child has the following food allergies or other medical concerns:

Child #3

Child's Name

Gender Male Female

Birthdate

Grade (as of Sept 1, 2022)

School my child attends:

Lakewood Kids Classes my child will usually attend (choose all that apply): Sunday morning, 9:00 AM Sunday morning, 10:45 AM Tapestry - Tuesday morning Clubhouse - Wednesday evening

The most important thing to know about this child is:

My child has the following food allergies or other medical concerns:

For families with more than three children, complete and submit this form and then begin a new form for your other children.

OAPs! (Other Authorized Pickups)

Tell us who else is authorized to pick up your kids!

OAP Name

OAP's Relationship to Child

OAP's Phone

Media Release

By registering my child for Lakewood Kids Ministry, I hereby give permission to Lakewood Free Church to take photographs and/or video of my child and use them in any Lakewood Kids publications. Publications may include but are not limited to: brochures, church website, posters, bulletin boards, announcement slides and/or video.

I give permission to Lakewood Free Church to use my child's photograph/video in their publications.

I agree to Lakewood Kids Media Release Statement.

Yes No

Medical Release

By registering my child for Lakewood Kids Ministry, I hereby release Lakewood Free Church and its representatives from any liabilities arising from treatment of any illness, injury or accident incurred during my child's participation in program activities. In the event of a medical emergency where I cannot be reached, I grant permission to Lakewood Kids, Lakewood Free Church, and attending health care professionals to provide medical treatment as required. I understand my own medical insurance will be the primary coverage and that Lakewood Free Church will cover any excess within established limits.

I have read and understand the Medical Release.

Yes No

Getting Involved in Lakewood Kids

Tell us how you'd like to be a part!

What areas of Lakewood Kids Ministry most interest you?

LK Ministry Registration, 2022

Description

Please Fix the Following