Summit Kids Registration

Child's Name

First Name

Last Name

Parent/Guardian Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Subject

Message

Primary Phone

(###)

###

####

Alternate Phone

(###)

###

####

Email Address

Child's Date Of Birth

YYYY

Entering Grade (2018-2019)

Medical Or Other Information We May Need To Know

Emergency Contact Other Than Listed Above

First Name

Last Name

Child #2 Name

If no other children to register please skip to "Dismissal Information" question

First Name

Last Name

Child #2 Date Of Birth

YYYY

Child #2 Grade Entering (2018-2019)

Medical Or Other Information We Need To Know For Child # 2

Child #3 Name

First Name

Last Name

Child #3 Date Of Birth

YYYY

Child #3 Grade Entering (2018-2019)

Medical Or Other Information We Need To Know For Child # 3

Child #4 Name

First Name

Last Name

Child #4 Date Of Birth

YYYY

Child #4 Grade Entering (2018-2019)

Medical Or Other Information We Need To Know For Child #4

Dismissal Information- Who May Pick Up Your Child(ren)

We ask a parent, guardian, or relative over the age of 18 sign out each child

First Name

Last Name

Who Else May Pick Up Your Child(ren)

We ask a parent, guardian, or relative over the age of 18 sign out each child

First Name

Last Name

Does Your Child(ren) Attend Sunday School?

If So Where?

May We Have Permission To Photograph Your Child(ren)

Yes

May We Have Permission To use your Child(ren)'s Photograph For The Purpose Of Promotion?

Yes

Person's Name

By Submitting Your Name You Give Us Permission To Use Your Child(ren)'s Photo Or Video On Our Church Website And/Or Social Media

First Name

Last Name

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