Restoration Kids Registration '23 - '24 - New Friends!

Please fill out this form and click submit.

Parent or Legal Guardian Information

Name of Parent or Legal Guardian

*

Name of 2nd Parent or Legal Guardian

Email

*

This address will receive a confirmation email

Phone

*

Address

*

Child Information

Child #1

Name

*

Grade

*

Please select one option.

0-2 YRS PreK (3 YRS) PreK (4 YRS) Kindergarten 1st 2nd 3rd 4th 5th

Birthdate

*

Allergies or Special Instructions

Child #2 (If Applicable)

Name

Grade

Please select one option.

0-2 YRS PreK (3 YRS) PreK (4 YRS) Kindergarten 1st 2nd 3rd 4th 5th

Birthdate

Allergies or Special Instructions

Child #3 (If Applicable)

Name

Grade

Please select one option.

0-2 YRS PreK (3 YRS) PreK (4 YRS) Kindergarten 1st 2nd 3rd 4th 5th

Birthdate

Allergies or Special Instructions

Child #4 (If Applicable)

Name

Grade

Please select one option.

0-2 YRS PreK (3 YRS) PreK (4 YRS) Kindergarten 1st 2nd 3rd 4th 5th

Birthdate

Allergies or Special Instructions

Child #5 (If Applicable)

Name

Grade

Please select one option.

0-2 YRS PreK (3 YRS) PreK (4 YRS) Kindergarten 1st 2nd 3rd 4th 5th

Birthdate

Allergies or Special Instructions

Program Registration

Which different programs do you anticipate having your children be a part of this fall (this is not binding but will help us get a better idea of how best to minister to the kids so check all that apply)?

*

Please select all that apply.

Sunday Morning Nursery ages 0-3 (1st Service) Sunday Morning Nursery ages 0 - 3 (2nd Service) Sunday Morning Children's Church ages PreK - 2nd grade (1st Service) Sunday Morning Children's Church ages PreK - 2nd grade (2nd Service) Sunday School ages PreK - 5th grade Wednesday Nights ages PreK - 3rd grade Wednesday Nights 4th and 5th grades Imago Dei (Sunday Morning Buddies for children with special needs)

Special Needs

One or more of my kids have special needs and I would like to be contacted about the Imago Dei program.

Please select all that apply.

Please contact me

Medical Information

Emergency Contact Name

*

Emergency Contact Number

*

Primary Physician's Name

*

Primary Physician's Number

*

Is/are your child(ren) covered by personal/family medical insurance?

*

Please select one option.

Yes No

If yes, name of insurer:

Policy or group number:

Medical Release and Participation Agreement

1. I/We, the undersigned have legal custody of the child(ren) named above, a minor/minors, and give our consent for them to attend and participate in events and activities being organized by Restoration Kids, the children's ministry at Restoration Church Wausau. I/We acknowledge that participation in Restoration Kids events and activities involves risk to the child(ren) (and to the child's parent(s) or legal guardian(s), if the child is a minor), and may result in various types of injury including, but not limited to, the folowing: sickness, exposure to infectious/communicable diesease, bodily injury, death, emotional injury, personal injury, property damage, and financial damage.

2. In consideration for the opportunity to participate in Restoration Kids events and activities, I/We acknowledge and accept the risks of injury associated with participation in and transportation to and from all events and activities. I/We accept personal financial responsibility for any injury or other loss sustained during the activity or during transportation to and from the activity, as well as for any medical treatment rendered to the child that is authorized by Restoration Church Wausau or its agents, employees, volunteers, or any other representatives.

3. Further, I/We agree to assume financial responsibility due to property damage/loss caused by child(ren) and travel cost if child(ren) should become ill.

Indicate that you have read the above and agree by selecting

*

Please select one option.

I have read and agree. I do NOT agree.

Parent or Legal Guardian Name as Signature

*

2nd Parent or Legal Guardian Name as Signature

Photo Release: Restoration Church Wausau occasionally has the opportunity to use photos to promote our children's ministry. Uses might include a display board, slide show, pamphlet, church website, social media page, press release or newsletter.

*

Please select one option.

Yes, I approve of using photos of my child(ren). No, I do not approve of using photos of my child(ren).

Description

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