KidSpring Registration

Name of Child

Date of Birth

Name of Parent 1

Name of Parent 2

This address will receive a confirmation email

Cell Phone Number

Able to be Texted During Service? Yes No

Address

Allergies or Special Requirements

**I agree not to hold Wellspring United Methodist Church and its employees and members legally or financially liable for any illness, accident or injury to my child that may occur before, during or after any Nursery class. If my child should become ill or be injured and I cannot be contacted immediately, I agree that an employee of Wellspring United Methodist Church may, without liability, act in my stead in consenting to any medical treatment that he or she in good conscience deems to be in the best interest of my child. **I give my permission for any picture taken of my child to be used for promotional purposes.

I agree

Please Sign your Name:

Date

Description

Please complete this form for each child and click submit.

KidSpring Registration

Description

Please Fix the Following