2024/2025 Kids of the Kingdom Registration

Choose Age Group(Required)

Participant Information(Required)

Participant First Name Participant Last Name

Participant Preferred Name

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.

Kids of the Kingdom Registration Fee

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Quantity

Please enter a number from 1 to 1.

Total

Payment Method

MasterCard

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Card Number Expiration Date Security Code Cardholder Name

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