CW Kids Registration

This form is intended to be filled out once per household, and fits up to 6 students. However, if you need more space or your consent to the Releases differs per child, simply complete another form for additional students in your household.

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* 1. Parent/Guardian #1 Info

Name

Relationship

Email Address

Phone Number

Phone Type (Home/Mobile/Work)

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* 2. Parent/Guardian #2 Info

Name

Relationship

Email Address

Phone Number

Phone Type (Home/Mobile/Work)

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* 3. Home Address

Street Address

City

State

Zip Code

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* 4. Other Emergency Contact Info

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* 5. List others authorized to pick up your child(ren)

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* 6. Student #1 Info

Student's Name

Date of Birth

Grade in School

Male or Female

Allergies or other Special Notes (type "None" if not applicable)

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* 7. Student #2 Info

Student's Name

Date of Birth

Grade in School

Male or Female

Allergies or other Special Notes (type "None" if not applicable)

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* 8. Student #3 Info

Student's Name

Date of Birth

Grade in School

Male or Female

Allergies or other Special Notes (type "None" if not applicable)

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* 9. Student #4 Info

Student's Name

Date of Birth

Grade in School

Male or Female

Allergies or other Special Notes (type "None" if not applicable)

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* 10. Student #5 Info

Student's Name

Date of Birth

Grade in School

Male or Female

Allergies or other Special Notes (type "None" if not applicable)

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* 11. Student #6 Info

Student's Name

Date of Birth

Grade in School

Male or Female

Allergies or other Special Notes (type "None" if not applicable)

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* 12. Medical Release: As a parent/guardian, I give my permission for the above minor(s) to attend CrossWinds Church activities including regular CW Kids meetings and any special activities from September 4, 2020 to May 1, 2021. I authorize treatment under the direction of any licensed physician of the above minor(s) in the event of a medical emergency which in the opinion of the attending physician my endanger his or her life, cause disfigurement, physical impairment or undue discomfort if delayed. This authority is granted after reasonable effort has been made to reach me by phone. I will not hold the church, or their staff, administration, or workers, liable for any injury to or loss of possessions by the above minor(s) during any activity either on the church property or away, including regular meetings as well as special events.

YES, I give permission as stated above for my child(ren) regarding medical care

NO, I do NOT give permission for my child(ren) to receive medical care

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* 13. In lieu of your signature, please enter your initials:

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* 14. Photo Release: Photographs are sometimes taken of ministry activities for publicity and promotional purposes, which include, but are not limited to, in-house presentations, church web site, brochures and newsletters. By signing below, you are granting the church to use photographs of the above mentioned minor(s) as stated.

YES, I grant permission for use of photographs of my child(ren) as stated above

NO, I do NOT authorize use of photographs of my child(ren)

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* 15. In lieu of your signature, please enter your initials:

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* 16. COVID-19 Release: Exposure to COVID-19 is an inherent risk in any public location where people are present. I acknowledge that any procedures put in place by the church will not eliminate the risk of COVID-19 and I accept the risk of the above minor(s) participating in this activity.

YES, I consent to the above

CW Kids Registration

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* 1. Parent/Guardian #1 Info

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* 2. Parent/Guardian #2 Info

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* 3. Home Address

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* 4. Other Emergency Contact Info

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* 5. List others authorized to pick up your child(ren)

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* 6. Student #1 Info

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* 7. Student #2 Info

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* 8. Student #3 Info

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* 9. Student #4 Info

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* 10. Student #5 Info

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* 11. Student #6 Info

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* 13. In lieu of your signature, please enter your initials:

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* 15. In lieu of your signature, please enter your initials:

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* 16. COVID-19 Release: Exposure to COVID-19 is an inherent risk in any public location where people are present. I acknowledge that any procedures put in place by the church will not eliminate the risk of COVID-19 and I accept the risk of the above minor(s) participating in this activity.

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* 17. In lieu of your signature, please enter your initials: