KIC Registration 2016-2017

Student's Info

Student's Health Info

Parent/Guardian Info

I am the parent or legal guardian of the child listed on this form, and I am informed of the activities offered by Lord of Life Church. As a parent or legal guardian of my child, I hereby consent for my child to attend and participate in all activities provided by Lord of Life Church.

I give permission for my child to participate fully in all activities sponsored by Lord of Life Church.

In case of emergency, I understand that every effort will be made to contact me. If I cannot be reached, I hereby give Lord of Life Church permission to act in my behalf in seeking emergency treatment for my child in the event that such treatment is deemed necessary. I give permission to those administering emergency treatment to do so, using those measures deemed necessary. I understand that my insurance plan is the primary plan to pay for the dental, medical, or hospital care or treatment that is given to my child.

I give consent to all forms of transportation (personal vehicles, rented vehicles, commercial busses). Lord of Life Church is not responsible for transportation by non-Lord of Life staff.

It is your responsibility to notify Lord of Life's office or CYF staff of any changes in information, including, but not limited to: address, phone number(s), policy changes, change of health conditions, medications, etc).

Success! This form has been submitted. If you have another child to register, please submit another form.