Kids Club Registration

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Kids Club Registrationjosh@yarrowmb.org2023-09-14T15:14:24+00:00

Kids Club is for kids grade 2-6 and starts on September 27 and runs every other Wednesday from 6:30-8:00pm until December 6.

Yarrow MB Kids Club Registration

Childs Name *

First

Last

Birthdate *

Grade *

Second Childs Name

First

Last

Birthdate

Grade

Third Childs Name

First

Last

Birthdate

Grade

Address

Phone Number *

Email *

I give permission for YMB Church to contact me via email regarding Kids Club and Youth programs *

Yes
No

I give permission for my child to have their photo taken *

Yes
No

Do you have a home church? *

Yes
No

Parent/Guardian Name *

First

Last

Phone Number *

Emergency Contact *

First

Last

Emergency Contact Phone Number *

I hereby give permission for the bearer of this form to seek medical assistance from a licensed physician in the case of an emergency if they are unable to reach me. I hereby release Yarrow MB Church, its personnel and volunteer staff from all claims for damages arising from any accidents or injury caused by negligence or unforeseen circumstances during my child's participation in this program. I have custodial rights to this/these child/children. *

Yes
No

Are there any Allergies, Asthma, Diabetes, Seizure Disorder, Learning or Behaviour Disabilities or other healthcare or educational needs that we should know about? *

Yes
No

If YES, please write any medications, allergies, or instructions in the space provided with the child's name included. Be sure staff attention is drawn to any special instructions. This information will be kept confidential by Kids Club Staff.