Kids Programs Registration

"*" indicates required fields

CRM Perks Submission Type

Select a kids program:*

Parent/Gardian Information

Información del Padre/Guardián

Name // Nombre*

First Last

Email // Correo Electrónico*

This must be your own email address

Phone // Numero Telefónico*

Address // Dirección*

Street Address City State ZIP Code

Child registration*

Add children

Child Info

Hidden

Program Registration*

Read Only

Registered Children

Read Only - This is a list of children you have registered during this session.

Parent/Guardian Name

Read Only

First Last

Parent/Guardian Email*

Read Only

Child Name*

First Last

Parent/Guardian relationship to this child:*

Child Birthdate*

Child Gender

Male

Female

Other

Child Home Address

Does this child live at the same address as the Parent/Guardian?

Yes, same address as Parent

No, lives at different address

Child Address

Street Address City State ZIP Code

School Information*

Yes, this child is in school

No, this child is NOT in school

School Name*

Grade Level*

Shirt Size:

US Shoe Size

Does this child have allergies, take medication, or have other special medical needs?*

¿Alguno de los niños tiene alergias, toma medicamentos o tiene alguna necesidad medica?

Yes

List allergies, medication or other medical information:*

Emergency Contact Name*

Emergency Contact Phone*

Emergency Contact Email

Parent / Guardian Consent // Consentimiento de Padre / Guardián*

In the light of the ongoing pandemic COVID-19 I understand that Neighborhood Ministries, Inc. cannot prevent the exposure, spreading and contraction of COVID-19, I understand that Neighborhood Ministries, Inc is working to implement the guidelines recommended by the Federal, State and Local authorities, therefore Neighborhood Ministries Inc. their employees, directors, managers, volunteers and other representatives will be held harmless for my child being exposed, spreading or contracting COVID-19. I authorize my child to participate in group activities in light of COVID-19.

I understand that Neighborhood Ministries, Inc. and their volunteers will be held harmless for any accidents or injuries that may be incurred during any of the Kids Club 2021. I understand that every effort will be made to contact me in the case of an emergency. I authorize Neighborhood Ministries, Inc. to obtain medical assistance for my child should this be necessary.

If I cannot be reached, I hereby give Neighborhood Ministries, Inc. the permission to act in my behalf in seeking emergency treatment for my child. I give permission to those administering emergency treatment to do so. I absolve Neighborhood Ministries, Inc. from liability in acting on my behalf in this regard.

I hereby grant the Neighborhood Ministries Inc. and partnering organizations permission to take and use my likeness in a photograph in any and all of its publications, including website entries, without payment or any other consideration. I understand and agree that these materials will become the property of Neighborhood Ministries and will not be returned.

I understand that my child will not be accepted in the program unless a parent or legal guardian signs this form.

I understand that if I allow my child to attend and ride with Neighborhood Ministries, Inc and their volunteers, I am giving permission at my own will.

español:
A la luz de la pandemia actual del virus COVID-19, entiendo que Neighborhood Ministries, Inc. no puede evitar la exposición, propagación y contracción de COVID-19, entiendo que Neighborhood Ministries, Inc. está trabajando para implementar las pautas recomendadas por las autoridades federales, estatales. y autoridades locales. Por lo tanto, Neighborhood Ministries Inc., sus empleados, directores, gerentes, voluntarios y otros representantes serán indemnes por el hecho de que mi hijo esté expuesto, propague o contraiga el virus COVID-19. Autorizo a mi hijo a participar en actividades grupales a la luz de COVID-19.

Entiendo que Neighborhood Ministries, Inc. y sus voluntarios serán eximidos de responsabilidad por cualquier accidente o lesión que pueda ocurrir durante cualquiera de los Kids Club 2021. Entiendo que se hará todo lo posible para contactarme en caso de una emergencia. Autorizo a Neighborhood Ministries, Inc. a obtener asistencia médica para mi hijo en caso de que sea necesario.

Si no pueden comunicarse conmigo, por la presente doy permiso a Neighborhood Ministries, Inc. para actuar en mi nombre en la búsqueda de tratamiento de emergencia para mi hijo. Doy permiso a quienes administran tratamiento de emergencia para que lo hagan. Absuelvo Neighborhood Ministries, Inc. de responsabilidad al actuar en mi nombre en este sentido.

Por la presente otorgo a Neighborhood Ministries Inc. y a las organizaciones asociadas permiso para tomar y usar mi imagen y la de mi hijo en una fotografía en todas y cada una de sus publicaciones, incluidas las entradas al sitio web, sin pago ni ninguna otra consideración. Entiendo y acepto que estos materiales pasarán a ser propiedad de Neighborhood Ministries y no serán devueltos.

Entiendo que mi hijo no será aceptado en el programa a menos que un padre o tutor legal firme este formulario.

Entiendo que, si permito que mi hijo asista y viaje con Neighborhood Ministries, Inc y sus voluntarios, estoy dando permiso por mi propia voluntad.

Check the box to indicate that you are an authorized parent or guardian and have read and agree to the terms above. / Marque la casilla para indicar que es un padre o tutor autorizado y que ha leído y está de acuerdo con los términos anteriores.

Signature

Select*

Add another child / otro niño

Finish

Hidden

Payment

Kids Club is $10 dollars per child, with a maximum household cost of $40.

Hidden

How many children did you register?

Hidden

Registration Amount

Select the number of children being registered.