KFC Registration

REGISTRATION FORM

CHILD'S INFO

* Indicates required field

Child's Name *

First

Last

Siblings' Names *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Date of Birth *

Age *

SCHOOL

School *

Grade *

FAMILY/CONTACT

Parent's Name *

First

Last

Phone Number *

Emergency Contact *

First

Last

Emergency Contact Phone *

Home Church *

Email Of Parent/Caretaker *

Other Information We Should Be Aware Of *

ALLERGIES

ALLERGIES? *

YES NO

List Allergies Here: *

ARRIVAL/TRANSPORT

Check What Applies *

My child will walk to KFC I will bring my child to KFC My Child needs to ride the church van

*If your child is riding in the van, please inform the child's school.

DEPARTURE

My Child Will *

Walk Home Be Picked Up

Name of Authorized Person *

First

Last

Name of Authorized Person *

First

Last

PHOTO RELEASE

Photos may appear on the church website, newsletter, or Facebook page.

Yes! I understand my child may appear in photos. *

I understand and give consent to photographs.

Submit