Kids Ministry Information

Hello! We at Harvest Time are so excited that you and your kid/s are here!

For the safety of your child, please fill out this information in case of an emergency.

Your info will be added to Breeze, our online church directory. All minor information is automatically set to private. You may always login to your profile and change your privacy settings. A link to Breeze will be sent in your confirmation email.

Parent Name

This address will receive a confirmation email

Phone

Address

Child's FIRST and LAST Name

Birthday

Current Grade (if applicable)

Please select one option.

Nursery (0-2) 3 Preschool (3-4) K 1st 2nd 3rd 4th 5th

Allergies (List N/A if none are known)

By checking this box, I am indicating that I DO NOT GIVE Permission for my child’s image to be used.

Please select all that apply.

Please do not photograph my child.

In case of an emergency

Although it is our sincere desire to provide a safe environment for our children, we also recognize that accidents can, and sometimes do, happen. If such a situation should occur, our first response will be to contact you, the parent, unless it is a life-threatening injury where it would be wise to seek immediate medical attention. The purpose of this form is to allow us to obtain first aid care for your children if we are unable to contact you.

I give permission for my student to receive emergency medical treatment by professional medical personnel in the case of injury or illness while he/she is in the care of Harvest Time Bible Church.

Please select all that apply.

Yes No

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Relation to child

Kids Ministry Information

Description

Please Fix the Following