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Kids Club Registration

Rhema Kids Club Registration Form

This registration form is to be completed by all parents of children attending the Rhema Kids Homework Club. The purpose of this form is to assist us in providing a safe and secure environment for children who participate in our programs or are under our care.

How many children would you like to register?

Child’s Information

First Name *

Last Name *

Date of Birth *

Month

Day

Year

Gender *MaleFemale

Street Address *

Apartment, suite, etc

City

Province

Postal Code

School Information

School name

Grade currently attending

Child’s Information (2)

First Name *

Last Name *

Date of Birth *

Month

Day

Year

Gender *MaleFemale

School Information (2)

School name

Grade currently attending

Child’s Information (3)

First Name *

Last Name *

Date of Birth *

Month

Day

Year

Gender *MaleFemale

School Information (3)

School name

Grade currently attending

Child’s Information (4)

First Name *

Last Name *

Date of Birth *

Month

Day

Year

Gender *MaleFemale

School Information (4)

School name

Grade currently attending

Child’s Information (5)

First Name *

Last Name *

Date of Birth *

Month

Day

Year

Gender *MaleFemale

School Information (5)

School name

Grade currently attending

Parent/Guardian Information

Parent's First Name *

Parent's Last Name *

Parent's Phone *

Parent's Email Address *

Is contact address different from above? *NoYes

Street Address *

Apartment, suite, etc

City

Province

Postal Code

Emergency Contact if you cannot be reached

First Name *

Last Name *

Phone *

Email Address *

Allergies

Does your child(ren) have any allergies or health concerns?NoYes

What is he/she allergic to? *

Additional Comments

Consent

Please check the box next to each statement, that you have read, understood and agreed to the following.

Snacks/Dinner will be served. We will strive to honor all food allergies/requests. Please also encourage your child to be informed about what they can and cannot eat or drink.

Rhema Kids Club is a positive environment. We will do everything within our power to help children succeed. In the unlikely event that a child becomes a consistent distraction or endangers themselves or others, we reserve the right to restrict their participation.

I understand that during Rhema Kids Club programming, Christian educational and experiential practices such as Bible stories, scripture verses, Christian songs, prayer times, and discussion will be integrated in a child-friendly, non-coercive manner. Children from any faith background are welcome to attend, however Christian values and beliefs will be presented.

I give Rhema Kids Club permission to take photos or videos (digital or otherwise) of myself, my child(ren)/family members for use in educational materials, publications, promotional materials, their website, Facebook and other social media sites and/or other materials and release Rhema Kids Club and all persons acting under its authority from any claims I might have due to the initial or subsequent publication of such materials. Children’s names will not be used.

Rhema Kids Club includes a variety of activities. I acknowledge that personal injury, etc. is always a possibility when children are active. In the unlikely event of an emergency, every effort will be made to contact you or your emergency contacts for permission to seek medical help for your child. If you cannot be reached, we will call emergency medical help.

Transportation to and from Rhema Kids Club is the parent’s responsibility. Pick up should be no later than 4:30 pm and check out is required. Please note that a late fee of $10.00 will be charged for children who are picked up after 4:45 p.m., unless prior arrangements have been made.

I hereby acknowledge that I have voluntarily registered my child in the Rhema Kids Club program. I am aware of the risks that may arise out of participation in Rhema Kids Club activities including but not limited to gym, games, playground time and crafts. I agree on my behalf and on the behalf of my family that Rhema Kids Club shall not be liable for any personal injury, death, or property loss, and I indemnify Rhema Kids Club from any such claims for negligence, or breach of statutory duty of care on the part of Rhema Kids Club or its directors, officers, employees, or volunteers, and I waive the right to make any claim with respect thereto.

I agree with the terms and conditions regarding Homework Club.

Parent/Guardian Signature *By checking the above boxes and typing my name, I certify that all information on this form is true and correct. I also agree that the checkbox and my name typed below are to be used as my electronic signature.

Come fellowship with one another and with the Father of light.
Talk to someone about Christ. Invite someone to church as well.

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