Foothills Baptist Church - AR - Kid's Konnection Registration

Registration for Kid's Konnection

Please fill out this form for each child you are registering. Fill out completely
Kid's Konnection meets every Wednesday when school is in session @ 5:30 PM
Supper will be served each Wednesday Night

Child's First Name

Child's Last Name

Address 1

Address 2

City

State

Zip/Postal Code

Parents Phone Number

Alternate Number

Child's Age

Birthdate

Parents Email

Emergency Contact

Emergency Contacts First Name

Last Name

Relationship to Child

May we takes pictures of your child?
Yes
No

Does your child need a ride?
Yes
No

Who can pick up your child?

Parents/Guardians: PLEASE READ CAREFULLY AND ACKNOWLEDGE. IF YOU SELECT NO, THEN YOUR CHILD WILL NOT BE ABLE TO PARTICIPATE IN KID'S KONNECTION. By submitting this form, you release Foothills Baptist Church, it’s volunteers and staff, from any liability of injury to you child as a result of an accident. You also authorize medical treatment, and if needed, transportation to the nearest hospital, in case of an emergency. Do you accept? (select yes or no below
Yes
No

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Registration for Kid's Konnection

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