Xtreme Visitor Registration

Parent / Guardian Name: * First Last

Parent / Guardian Name: First Last

Email *

Child Info Section

Please enter the info about your child(ren) below

Relationship to Children listed below? *

1st Child's Name * First Last

Age *

Grade *

Gender

2nd Child's Name First Last

Age

Grade

Gender

3rd Child's Name First Last

Age

Grade

Gender

4th Child's Name First Last

Age

Grade

Gender

Please provide any additional information our staff would need to ensure your child receives the best experience possible.

To include allergies, physical limiations, or special needs.

Emergency Contact

Please list an emergency contact for your child(ren)

Name * First Last

Relationship to Child *

Waiver

I have read and I am in full agreement with the policies and procedures expressed in the Policies Guide for Xtreme Family Ministry. I understand that it is my responsibility to abide by these rules to the best of my abilities. I recoginize that Xtreme Children's Church or Xtreme Toddler Care are not responsible for personal property lost or stolen while members and/or program participants are using Xtreme facilities or on Zion Church's premises.

I give permission to Xtreme Family Ministry to use, without limitation or obligation, photographs, and audio video recording footage of my child's image, or voice for the purpose of promoting or interpreting Xtreme Family Ministry programs. I furture acknowledge the waiver and accept the conditions set forth above.