Liberty Church Of the Nazarene - Kids/Youth Registration Form

Welcome to Liberty Nazarene Kids and Youth Ministry!

Thanks for joining us!

This form is for first-time visiting families who would like to register their child(ren) for our Kids or Youth ministry programs.

Parent/Guardian Information

First Name

Last Name

Email

Phone Number

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

How did you hear about us?

Child Information

Child's First Name

Child's Last Name

Birthdate

Gender

Grade

Allergies

Which program(s) are you registering for?

Pre-school (ages 3 -5 years)

Kids Ministry (K - 6th grade)

Youth Group (7th - 12th grade)

Vacation Bible School (VBS)

Any special needs or accommodations we should know about?

Does this child have any medical conditions requiring an action plan?

Please describe the medical condition and action plan

Agreements and Authorizations

Photo/Video Release

We occasionally take photos and videos during our Kids and Youth Ministry events for our website, social media, and promotional materials.

Photo/Video Release

I grant permission

I do not grant permission

Authorized Pickup Contacts

List anyone other than yourself that is authorized to pick up your child(ren).

Authorized Pickup Contacts

Parent/Guardian Signature

By signing below, I certify that all information provided above is accurate, and I authorized Liberty Church of the Nazarene to care for my child(ren) during Kids and/or Youth Ministry programs and events.

Signature

Kids & Youth Registration Form

Welcome to Liberty Nazarene Kids and Youth Ministry!

Parent/Guardian Information

Child Information

Agreements and Authorizations

Photo/Video Release

Authorized Pickup Contacts

Parent/Guardian Signature

About

Service Times

Contact Info