New Life Kids Family Information

Parent / Guardian Name(s):

Address:

Cell Phone Number:

Secondary Phone Number:

Email:

Emergency Contact (in the event we are unable to reach you):

Emergency Contact Name:

Emergency Contact Phone Number:

Relationship to Child:

Permission to Check-In / Check-Out (in addition to parents - must be at least 16 years old):

Photo & Media Permission

I give permission for photos & video to be used internally only (photo displays, slideshows, etc.):

Yes No

I give permission for photos & videoto be used publicly (church website & social media):

Yes No

Parent / Guardian E-Signature (By signing this document electronically, I agree that my electronic signature is the legal equiavalent of my manual/handwritten signature on this document. I represent and warrant that I am the minor's parent or legal guardian.):

Date of E-Signature:

Child 1:

Name:

Gender:

male female

Birthdate (month/day/year):

Grade (as of September):