KID'S REGISTRATION

This form is to register your child at Destination Kids. The information we collect here is just for our system and is never shared with anyone else. We have a no hassle policy when it comes to contact. We won't be coming out to your house or bothering you on the phone. We just want to send you a letter thanking you for checking us out.

1 - general information

This section contains basic information about your child and their visit to Destination Kids. Please fill out what ever you feel comfortable giving Destination Church. For safety reasons some sections are mandatory.

Child's Name

Include first, middle, and last name.

Child's Nickname (If applicable)

Gender

Birthdate:

YYYY

Grade/Agility

School

What school does your child attend?

T-Shirt Size

All sizes are youth.

Invited By

If you or your child were invited by someone currently attending Destination Church, you may write their name here.

Date attended

If your child has already attended Destination Church before, please enter the first date of attendance here.

YYYY

Does your child have any medical issues that we should know about?

Medical issues include allergies, medications, medical conditions, and diaper changing issues or bathroom assistance issues.

2 - MEDICAL INFORMATION

Please list any important medical information below. This information is confidential and is only accessible by Destination Church staff and Destination Kid's volunteers.

Medical Conditions

Please list any important medical conditions below.

Allergies

If you child has any allergies please list them below.

Medications

If you child takes any medications on a regular basis please list them below. Please note that Destination Kid's staff and volunteers will not administer any medications nor permit any child to have medications on them, with the exception to fast acting medications such as insulin, inhalers, and EpiPins, while attending Destination Kids. If your child does have fast acting medication then please identify them as such below. This information is primarily to give to medical professionals should an emergency situation arise.

Is it okay to change your child's diaper?

Checking the box below means that if your child soils their diaper we will not change it and they will stay in their soiled diaper for the remainder of service.

It is NOT okay to change my child's diaper.

Is it ok to assist your child in the bathroom?

Younger children who are being potty trained may require assistance in the bathroom. If you do not wish for us to assist your child in the bathroom then check the box below.

I do not want my child to be assisted in the bathroom.

Contact Info

The following information is helpful when attempting to contact you or your child. The next section contains places to put down contact info for the parents. Please fill out whatever you feel comfortable giving Destination Church. Remember, we do not share your contact info with anyone, and we promise not to bother you with multiple phone calls. We will occasionally send you our e-newsletter to keep you informed about everything going on at Destination Kids. You may always opt-out of this publication. A hard copy of our newsletter is also available every Sunday morning at the Destination Kid's check-in desk.

Address

What is the primary street address for your child?

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home phone

What is the home phone number of the place where the child lives?

(###)

###

####

Is it okay to contact you using your home phone?

3 - Family Information

This section contains information about your family. This will help us better get in contact in case there is a problem. Please fill out as much as you feel comfortable sharing with Destination Church. For safety reasons some information is mandatory.

Mother's Name

First Name

Last Name

Mother's Email

Is it okay if we email you?

Mother's Cell Phone

What is the mother's cell phone number? This question is mandatory because we may to contact you if there is a problem during service. Remember, if you have a child in Destination Kids please keep your phone on vibrate during service.

(###)

###

####

Cell phone provider

What company provides this number with service?

Is it okay to call you at this number?

Is it ok to text you at this number?

Mother's Work Phone

(###)

###

####

Is it okay to call you at this number?

Custody concerns?

Are there any custody concerns we should know about? If so, briefly describe them here.

Father's Name

First Name

Last Name

Father's Email Address

Is it okay to email you?

Father's Cell Phone

What is the father's cell phone number? This question is mandatory because we may to contact you if there is a problem during service. Remember, if you have a child in Destination Kids please keep your phone on vibrate during service.

(###)

###

####

Cell Phone Provider

What company provides this cell phone with service?

Is it ok to call you at this number?

Is it ok to text you at this number?

Father's Work Number

(###)

###

####

Is it okay to call you at this number?

Custody concerns?

Are there any custody concerns we should know about? If so, briefly describe them here.

Optional Emergency Contact 1

If you would like to add information for an additional emergency contact, you may do so below. If not, press "Submit".

Name

First Name

Last Name

Home Phone

(###)

###

####

Cell Phone

(###)

###

####

Work Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

optional emergency contact 2

If you would like to add information for an additional emergency contact, you may do so below. If not, press "Submit".

Name

First Name

Last Name

Home Phone

(###)

###

####

Cell Phone

(###)

###

####

Work Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country