Kid’s Nite 2025 Child Registration

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Child's Name

*

Email

*

This address will receive a confirmation email

If you attended VBS we have your information. Just check ‘Yes’.

*

Please select all that apply.

Yes No

If you answered 'Yes' to the question above you do not need to fill out the remainder of the form. Skip ahead and click submit.

Grade

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Pre-Kindergarten Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade

Gender

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Male Female

Allergies

Other Needs

Parent's Name

Phone

Address

Authorized Pick-up

Does this child have any special needs or medical conditions that may prevent participation in any activities? Is so, list below. If not. write NONE.

I agree to allow pictures or video that may include my child to be a part of event related presentation. I understand all will be in good taste. I agree to hold harmless and indemnify MovementChurch.online, its directors, employees and volunteers from any and all liability as a result of willful, intentional or negligent act of said participants.

Parent Signature

Description

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Please Fix the Following

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