PLATTEVALLEY BAPTISTCHURCH

Bus Ride

Please pick up my child for KWAM.

Yes

No

Parents Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Child 1

First Name

Last Name

Gender

Male

Female

Birthdate

MM

DD

YYYY

Child 2

First Name

Last Name

Gender

Male

Female

Birthdate

MM

DD

YYYY

Child 3

First Name

Last Name

Gender

Male

Female

Birthdate

MM

DD

YYYY

Child 4

First Name

Last Name

Gender

Male

Female

Birthday

MM

DD

YYYY

Consent *

I hereby give permission for my child to attend this church. I also give my permission for images of my child, captured during regular and special KWAM activities through video, photo, and digital camera to be used for the purposes of church promotional material and publications, and waive any rights of compensation or ownership thereto. I also understand, that I am agreeing to this waiver digitally.

Agree

Disagree

Skating Party Release

I give my children, listed above, permission to attend the end of year skating party on April 30, 2019, at the Brush Skating Rink for 6:00-8:00. No transportation will be provided to the skating party. In case of emergency, I give permissions for my child to receive medical treatment. In case of such emergency, we will contact the number(s) on this registration form.

Agree

Disagree

Remind *

We use the "remind" app to send out updates concerning our KWAM schedule. You will simply receive a text message if there is updated information. We use this app to let you know of cancelations due to weather, if your child is sick, etc. This just allows us to communicate with each family.

Yes, add my phone number to the KWAM remind

No, don't add my phone number to the KWAM remind