KC Registration

Online Registration

* Indicates required field

Today's Date (MM/DD/YYYY) *

Child's Information

Name *

First

Last

Gender *

Male Female

Date of Birth *

Grade *

School *

Allergies/Special Needs *

Invited to Kids Community By: *

Parents'/Guardians' Information

Father/Guardian 1's Name *

First

Last

Father/Guardian 1's Email *

Father/Guardian 1's Mobile# *

Mother/Guardian 2's Name *

First

Last

Mother/Guardian 2's Email *

Mother/Guardian 2's Mobile# *

Mailing Address *

Line 1

Line 2

City

State

Zip Code

Country

Home Phone *

Cell Carrier *

Can recieve text message reminders about upcoming events, deadlines, and schedule changes *

Yes No

Name of Church you Regularly Attend *

Additional Comments *

Photo Release
I grant to Beautiful Savior Lutheran Church (BSLC), the right to take photographs of me and my family in connection with Fun and Friends. I authorize BSLC, its assigns and transferees to copyright, use and publish the same in print and/or electronically.

I agree that BSLC may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content.

I have read and understand the above Photo Release policy:

Parent / Guardian E-Signature (Full name & DOB) *

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