KIA Registration Form

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Please fill out the form below to register your child for our Kids in Action mid-week program.

KIA Registration

Child 1:
Student Name:
(required)
Grade:
(required)
Age:
(required)
Birthdate:
(required)
Child 2:
Student Name:
Grade:
Age:
Birthdate:
Child 3:
Student Name:
Grade:
Age:
Birthdate:
Child 4:
Student Name:
Grade:
Age:
Birthdate:
Please Note: If you need to register more children, please fill out another form.
Mother/Guardian Name:
(required)
Father/Guardian Name:
Street Address Line 1:
(required)
Street Address Line 2:
City:
(required)
State:

(required)
Zip:
(required)
Email:
(valid email required)
Home Phone:
(required)
Cell Phone:
Emergency Contact Name:
(required)
Emergency Contact Phone:
(required)
Food Allergies/Health Problems:
I need assistance with the meal fees (Patti will contact you)
Supervised recreation is available in the Gym from 5:00 to 5:30 p.m. Rules will have to be followed.
My child will participate in recreation time and will be picked up at 5:30 PM by an adult
My child will participate in recreation time and will be taken to the Fellowship Hall at 5:30 PM and checked-in with a table parent. ( A meal ticket will have to be purchased for your child. Please leave the money with your child/ren)
My child will not participate in recreation time
I will select the following participation option:
My child/ren will attend the program from 6 to 7 PM only (no meal)
My child/ren will be walked into the Fellowship Hall to eat a meal with the Table Parent Hosts
I will eat with my child/ren and escort them to the appropriate classroom beginning at 5:55 PM.
Dates I can help in the classroom:
I have read and agree to the Code of Conduct and the Classroom Commitments
All information collected by Kerrville First United Methodist Church (KFUMC) will be used for the purposes of Kids in Action. We never sell, rent, lease or exchange your personal information with other organizations. Contact information will be added to KFUMC’s mailing lists to inform you of future programs within KFUMC, unless you notify us in writing. Individual and group photos along with video will be taken of your child(ren) during KIA for distribution to participants and for use at KFUMC unless you inform us in writing otherwise.
I, the parent or legal guardian of the above named child(ren) allow him/her/them to attend Kids in Action at KFUMC. I recognize the risk involved in activities and will not hold KFUMC, its staff or volunteers responsible for any personal injury that might occur to my child(ren) while participating in this program. I authorize a KFUMC staff member or volunteer to seek and obtain such emergency or medical services for my child(ren) as deemed necessary at the time.

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KIA Registration Form

Please Note: If you need to register more children, please fill out another form.

Supervised recreation is available in the Gym from 5:00 to 5:30 p.m. Rules will have to be followed.

I will select the following participation option: