Kids Kingdom Registration Form

Wednesdays 3:00 p.m. to 5 p.m.
For students in kindergarten through fifth grade
Kids Kingdom will meet each Wednesday starting
October 2nd - February 26th from 3:00 - 5:00 pm. 
We wil have homework, and then group up for
Bible study and fun! 

Cost is $25 for the session
Parent/Legal Guardian

 
Please select one option.
 
Please select one option.
Contact Information

 
 
 
 
Student(s)

 
 
Please select one option.
Please select one option.
 
 
 
Please select one option.
Please select one option.
 
Emergency Contact

 
 
 
Medical Information

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Authorization of Consent to Treat a Minor

I do hereby authorize Trinity Church children's ministry leaders as agents for the undersigned to consent to any x-ray, examination, anesthetic, medical or surgical diagnosis or treatment and hospital care which is deemed advisable by, and is to be rendered under the general or specific supervision or any, physician and surgeon licensed under the provision of the Medical Practice Act, whether  such diagnosis is rendered at the office of said physician or at a hospital. It is understood that this authorizationis given in advance of any specific diagnosis, treatment, or hospital care being required, but is given to provide authority and power on the part of aforesaid agents to give specific consent to any and all such diagnosis, treatment, or hospital care which the aforementioned physician in the exercise of his/her best judgement may deem advisable. The authorization is given pursuant to the provisions of Section 25.8 of the Civil Code of California. Thie authorization shall remain effective through the above names minor's graduation from high school, unless sooner revoked in writing delivered to said agents. 
Release of Trinity Church

I understand that I shall indemnify, hold free and harmless, assume liability for, and defend Trinity Church and its agents, servants, employees, officers, volunteers, and directors from any and all costs and expenses including, but not limited to, attorney's fees, reasonable investigative discovery costs, court costs, and all other sums which Trinity Church, assertion of liability, or any claim or action found thereon, arising or alleged to have risen out of students(s) use of real or peronal property belonging to Trinity Church and its agents, servants, employees, officer,s and directors, or by any action or omission by student(s). 
Consent to Take and Publish Photographs, Videos, Audio & Media Recordings

I hereby grant Trinity Church, its agents, and those by whom it is commissioned, unrestricted and unlimited license, right permission and consent to use and reuse, copyright, print, reproduce, publish and republish for any and all trade purposes or commercial or other advertising or public purposes, said media usage depicting me or a minor for whom I have legal responsibility. I warrant that I have not limited or restricted the use or my name or photograph to the use of any organization or person. 
Volunteers

Kids Kingdom is a 100% volunteer run program. Please take a moment to see how you can help make Kids Kingdom a success. Thank you!
Please indicate where you would like to serve.
Please select all that apply.

Description

Wednesdays 3:00 p.m. to 5 p.m.
For students in kindergarten through fifth grade