KFC Online Registration

* Child's name

* Today's Date

Parent Information

* Parent's Name:

* Home Address:

Mailing Address (if different from Home Address):

If home and cell phone are same, fill in home phone:

* Your email

Emergency Contact Information:

If home and cell phone are same, fill in home phone:

* Child Lives With Whom; (Please put relationship then name(s)
Examples: Parents - John and Jane Doe, Mom - Jane Doe, Dad - John Doe, Grandparents - John and Jane Smith, Other (please explain)

* Medical conditions, special needs, latex, food or other allergies:YesNo
Please list:
none

* My child will be walking with KFC staff directly from school (permission needed at the school office)
NoYes

* My child will be picked up each Thursday at 5:00PM by a person who has my permission
NoYes

[group permission-one-selected]
[/group]

[group permission-two-selected]
* The following people have my permission to pick up my child at 5:00PM. Please list names and relationship :

[/group]

* My child will be walking home on Thursdays after KFC. Kids for Christ is not responsible for the safety of my child after 5:00PM
NoYes

Shut-In Ministry and Birthday Information

Attends church at: (if any) for example, Mill-Green UMC

A Thursday birthday party is held in the spring and each child receives a gift. Members of the Mill-Green UMC congregation pick a child’s name and the following information is on the child’s birthday sheet. Please check choices that apply and fill in the blanks.

* Child's Gender
-- Choose Child's Gender --GirlBoy
[group technical-support-selected]
Choose Features
Long HairShort HairPierced Ears

[/group]
[group sales-support-selected]

[/group]

Favorite two colors

Favorite things to do, i.e. activities, games, or hobbies

Favorite sports team (if any)

Any other helpful information (optional) none

* I give Kids For Christ permission to include my child in any photograph/film/video/church website or Facebook for any lawful purpose of the Kids For Christ Program.NoYes

After you hit "register" you will return to the sign-up if you wish to sign-up another child. Thank you for registering online! If you have any questions, please email Louise at the church office at office@millgreenumc.org or call 570-458-4349.