Child's Birthday *

MM

DD

YYYY

Child's address is the same as registering parent? *

yes

no

Authorize King City *

In the event of an emergency and/or life-threatening situation, I wish for my child to be transported to the below-mentioned hospital. I understand that King City will contact me and/or my designated contact person immediately.

yes

no

Authorize King City *

I hereby authorize the staff and director of the Parent's Day Out program at King City Church to give consent for any and all necessary emergency medical and first aid care for my above-mentioned child, while he/she is in King City Church's custody.

yes

no

May the non-custodial parent pick up the child?

King City Church must be provided with court-issued custody papers that clearly describe the custody arrangements. Any person granted custody in such paper may pick up the child during the time designated by the parent with custody, and may designate other persons who are authorized to pick up the child at such times, unless court papers state otherwise. Email custody paper(s) as an attachment to admin@kingcitylex.com

yes

no

Photo Release *

I give permission for King City Church to take and share photographs or videos of my above-mentioned child. These will be shared with classroom families via private classroom communication means, and occasionally used for publicity purposes.

yes

no

Images Sharing Restriction *

I also understand that sometimes other children at King City Church may be featured in the photos or videos of my child. By giving consent I agree not to share photos or videos of any other child, other than my own, without permission.

yes

no

Parent Handbook Acknowledgement *

I have reviewed the King City Church Parents Day Out program Parent Handbook which is located online at https://www.kingcitylex.com/s/PDO-Parent-Handbook-42225.pdf I understand the contents of this handbook give me reasonable expectation of how the program is operated and I should speak with the Director or administration if I have any questions about the program's policies and procedures.

yes

no