• ------- First Child's Information -------

  • ------- Second Child's Information -------

  • ------- Third Child's Information -------

  • ------- Parent/Guardian Information -------

  • Important! Please provide
  • ------- Emergency Contact Information -------

  • ------- Review and Submit -------

    I have reviewed all the information and it is complete to the best of my knowledge and I give my permission to the staff of Kidz Blast/Junior Youth to seek medical attention for my child(ren), if necessary, while participating in Kidz Blast functions. I understand that all necessary precautions will be taken for my child(ren)'s safety. I will not hold the church, its staff, or those supervising liable.
Translate »