SCC Kids Club Registration

Parents / Guardian*
Address*
Street Address Address Line 2 City State ZIP Code
Home Phone*
Parent Emergency Contact Phone*
Phone other than above such as a cell number where parent can be reached during clubs, Wednesdays 6:30-8:00pm
Email
Church Affiliation*
Other Emergency Contact*
Relationship to child(ren)
Phone*
Photo Release*
- Yes, I authorize photo use
- Yes, LIMITED--photos may be displayed at SCC but not on the SCC website
- No, I do not authorize photo use
Do you authorize SCC to use photos of your child for ministry purposes? (These photos may appear on bulletin boards or slideshows at SCC or on the SCC website.)
Electronic Signature*

By inputting my initials above, I hereby hereby give approval for my child(ren) to participate in SCC Kids Club at Shoreline Covenant Church. I release Shoreline Covenant Church and SCC Kids Club leaders and assistants from all liabilities pertaining to these activities. I authorize emergency medical care when deemed necessary.

Child 1