/files/Children's Ministry/2011 KidZONE/2KidsWeb.jpg2011-2012 Registration
This form is required for all children ages birth - 5th grade participating in ANY program at Wayside Chapel.  ONE PER FAMILY

Parent's/Legal Guardian's Information:

Last Name:    First Name(s):                       

Street Address:   City/Zip:   

Home Phone:  Cell Phone:    E-Mail: 

Children's Information: (Include last name if different from parent/guardian) 

Child's Name:  Sex:    DOB:  *Grade as of fall 11: 

Child's Name:  Sex:    DOB:  *Grade as of fall 11:

Child's Name:  Sex:    DOB:  *Grade as of fall 11:

Child's Name:  Sex:    DOB:  *Grade as of fall 11: 

Child's Name:  Sex:    DOB:  *Grade as of fall 11: 

                                                                                                          *If applicable

Describe any parent/guardian child custody arrangements we should know about: (optional)

Drug/food allergies:  (If you are registering more than one child, please include child's name with allergies)

List any medications your child is taking:  (If you are registering more than one child, please include child's name with meds)

Emergency Contact Information - Name:    Phone: 

Service attending:   Sunday ABF Attending                                                      

Weekday Bible Study

Willing to volunteer in KidZONE:   Nursery   Preschool   Elementary

Authorization/Waiver:  As parent or legal guardian for the children listed above, I hereby authorize and consent to the following:
1)  My child may be given reasonable emergency medical care and treatment in connection with all church events, and I authorize the person(s) in charge of the activity to administer, arrange for and authorize such emergency medical care and treatment in my place and stead. 
2)  My child may be photographed/videotaped for church-related media presentations.
3)  I knowingly and voluntarily WAIVE AND RELEASE all claims and causes of action of any kind whatsoever (other than for gross negligence or willful misconduct) against Wayside Chapel, its elders, pastors, officers, staff and volunteers, which I or my child may hereafter have by reason of or relating to my child's participation at Wayside Chapel, including injury, illness or death of my child and damage to any property of the property of my child.  I UNDERSTAND THAT THE CLAIMS AND CAUSES OF ACTION HEREBY WAIVED AND RELEASED INCLUDE THOSE BASED, IN WHOLE OR IN PART, ON THE ORDINARY NEGLIGENCE (BUT NOT GROSS NEGLIGENCE OR WILLFUL MISCONDUCT) OF WAYSIDE CHAPEL, ITS ELDERS, PASTORS, OFFERS, STAFF OR VOLUNTEERS. 

The submission of this online form will constitute my signature to the above authorization/waiver. 

(Click only once and wait 2-3 minutes for confirmation.) 
Enter the numbers as they
are shown in the image above