Kingdom Kids Lock-In

Kingdom Kids Lock in

Child's Name

First Name

Last Name

Child's Age

Parents Name

First Name

Last Name

Parent's contact number

(###)

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Parent's Email

Child's Medical Information

Please put name of insurance provider and policy number

Emergency contact name

First Name

Last Name

Emergency Contact Phone Number

(###)

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Medical Release

I am agreeing to the medical release waiver on the following page and release all liability from First Christian Church and any of its volunteers.