Kidzone Permission Form - Kidzone Permission Form
Kidzone Permission Form

I hereby grant permission for my child to participate in the Couts United Methodist Church KidZone activities for the 2017/2018 school year. Should any problems arise concerning the behavior of my child that would require them to return home prior to the end of the activity, I will come and pick my child up.
I authorize the treatment, by a qualified and licensed medical doctor, of the minor listed above in the event of any medical emergency which, in the opinion of the attending physician, is necessary and I/we cannot be reached after reasonable effort has been made to secure my personal consent.
Any medical expenses are the responsibility of the participant and their insurance carrier.
Checkbox *
 I grant permission 
Child's Name
 
 
First
Last
Parent's Name
First
Last
Address
Street Address
City
State / Province / Region
Postal / Zip Code
 
Email
Cell Phone Number

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Emergency Contact (other than listed parent)
First
Last
Emergency Contact Cell Number

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-
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Grade in school
Snacks (optional)
 I would like to donate money for snacks for Kidzone 
 I would like to provide snacks for Kidzone 
You can call the church office to sign up for a date - 817-599-8601 ext #10 (Cindy)
To donate money for snacks, drop it by the church office at your convenience.
Please list any allergies your child has
I will strive to have my child attend Kidzone every week. If they are sick or cannot be there, I will call the church office to let them know.
 yes 
I request that my child be picked up at the following Weatherford ISD school
 Austin Elementary 
 Bose Ikard Elementary 
 Crockett Elementary 
 Curtis Elementary 
 Mary Martin Elementary 
 Seguin Elementary 
 Wright Elementary 
You will need to notify the school that your child (children) will be picked up by Couts.