Christmas for Kids ~ Registration Form

NOTE: This one day event is from 9:00am – 12:00pm and open to children ages 4 to 9. Doors open at 8:45am; children must arrive before 9:15am to participate in this event.

Registration closes at the end of the day on December 11th 2016.
Please fill out the following form, click “Submit”

[contact-form][contact-field label=”Child’s Name” type=”name” required=”1″ /][contact-field label=”Date of Birth (MM/DD/YYYY)” type=”text” required=”1″ /][contact-field label=”Age” type=”radio” options=”4 years old,5 years old,6 years old,7 years old,8 years old,9 years old” required=”1″ /][contact-field label=”Parent/Guardian giving permission (First & Last name)” type=”text” required=”1″ /][contact-field label=”Street Address” type=”text” required=”1″ /][contact-field label=”City” type=”text” required=”1″ /][contact-field label=”State” type=”text” required=”1″ /][contact-field label=”Zip Code” type=”text” required=”1″ /][contact-field label=”Home Phone or Cell Phone – ie (xxx) xxx – xxxx” type=”text” required=”1″ /][contact-field label=”Emergency First & Last Name (If parent/guardian cannot be reached)” type=”text” required=”1″ /][contact-field label=”Emergency Contact Relationship to child” type=”text” required=”1″ /][contact-field label=”Emergency Contact Home Phone or Cell Phone – ie (xxx) xxx – xxxx” type=”text” required=”1″ /][contact-field label=”Allergies or other health information that we should be aware of” type=”textarea” /][contact-field label=” Additional Information” type=”textarea” /][contact-field label=”Name of Church home” type=”text” required=”1″ /][contact-field label=”How did you hear about this event?” type=”text” required=”1″ /][contact-field label=”We will have a Petting Zoo available. The child named below has permission to participate in the Petting Zoo while at the Christmas Party. I understand the risks that accompany this activity and that St. Matthew/Riverview and its volunteers are not responsible for possible injuries that may occur.” type=”text” required=”1″ /][contact-field label=”By typing in your name below, you are giving your child permission to participate at the Christmas for Kids, per the entries above. This is the same as if you were signing your name to a paper document.” type=”text” required=”1″ /][contact-field label=”Today’s Date (mm/dd/yyyy)” type=”text” required=”1″ /][/contact-form]