Kids of the Kingdom Early Bird Registration

1Participant Information

2Child Information

3Address

4Parent Information

5Medical Form

6Photo/Video Opportunities

7Payment

Choose Age Group(Required)

Participant Information(Required)

Participant First Name Participant Last Name

Participant Preferred Name

Gender(Required)

Prefer not to say

Which hour (9:30 or 10:45) will your child attend Kids of the Kingdom?(Required)

9:30

10:45

Grade in 2023/2024 School Year(Required)

PreK 3

PreK 4

PreK 5

Kindergarten

1st Grade

2nd Grade

3rd Grade

4th Grade

5th Grade

Date of Birth(Required)

MM slash DD slash YYYY

School attending in 2023/2024(Required)

Has your child been baptized?(Required)

Yes

Has your child received a Spark Story Bible? (Prek-2nd)(Required)

Yes

Has your child received a Spark Bible? (3rd-5th)(Required)

Yes

Has your child received First Communion? (4th and 5th)(Required)

Yes

Address Information(Required)

Street Address Address Line 2 City State ZIP Code

Parent/Guardian Name(Required)

Parent/Guardian Cell Phone(Required)

Parent/Guardian Email Address(Required)

Parent/Guardian 2 Name

Parent/Guardian 2 Cell Phone

Parent/Guardian 2 Email Address

Emergency Contact Name (if parent/guardian can't be reached)(Required)

Emergency Contact Primary Cell Phone #(Required)

Family Doctor Name(Required)

Phone(Required)

Hospital(Required)

Does your child have any allergies? (food or enviornmental) food tolerances or anything else they may encounter during programming/events?(Required)

Please list any allergies (including food tolerances)

Additional information you would like us to know (be sure to include any emotional, behavorial and/or special needs for participant)

Every participant is a unique learner and we do our best to meet the individual needs of participants. Would you like to be contacted by a staff member to help your participant be successful?(Required)

I (We) grant to King of Kings Lutheran Church the right to take photographs in connection with children/youth education classes, summer programs, and any other Church sponsored event. I (We) authorize King of Kings Lutheran Church, its assignees and transferees to copyright, use, and publish the same in print and/or electronically, including the King of Kings website, social media, video and secure web-based photo sharing. I (We) agree that King of Kings Lutheran Church may use such photographs or videos within internal print publications/slides.

We prefer to pay in person

True

Kids of the Kingdom Registration Fee Quantity

Price:

Quantity

Please enter a number from 1 to 1.

Total

Payment Method

MasterCard

Visa

Supported Credit Cards: MasterCard, Visa

Card Number Expiration Date Security Code Cardholder Name

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2023/2024 Kids of the Kingdom Early Bird Registration

2023/2024 Kids of the Kingdom EARLY BIRD