PEAK Kids Registration Form Church OfficeMarch 27, 2023McConnell Church PEAK Kids Registration Form Registration Form for Nursery, Peak Kids Sunday School, Peak Jr., PEAK Kids Worship, and Wednesday night PEAK Kids/Nursery "*" indicates required fields About Your Child(ren)How many children are you checking in today?*Please enter a number from 1 to 7.Child 1. Name* First Last Gender* Male Female Grade*Birth - 3yrs (Not Potty Trained)3 - 5 yrs and Potty TrainedKindergarten1st Grade2nd Grade3rd Grade4th Grade5th GradeBirthday* Month Day Year Age*Allergies Child 2. Name* First Last Gender* Male Female Grade*Birth - 3yrs (Not Potty Trained)3 - 5 yrs and Potty TrainedKindergarten1st Grade2nd Grade3rd Grade4th Grade5th GradeBirthday* Month Day Year Age*Allergies Child 3. Name* First Last Gender* Male Female Grade*Birth - 3yrs (Not Potty Trained)3 - 5 yrs and Potty TrainedKindergarten1st Grade2nd Grade3rd Grade4th Grade5th GradeBirthday* Month Day Year Age*Allergies Child 4. Name* First Last Gender* Male Female Grade*Birth - 3yrs (Not Potty Trained)3 - 5 yrs and Potty TrainedKindergarten1st Grade2nd Grade3rd Grade4th Grade5th GradeBirthday* Month Day Year Age*Allergies Child 5. Name* First Last Gender* Male Female Grade*Birth - 3yrs (Not Potty Trained)3 - 5 yrs and Potty TrainedKindergarten1st Grade2nd Grade3rd Grade4th Grade5th GradeBirthday* Month Day Year Age*Allergies Child 6. Name* First Last Gender* Male Female Grade*Birth - 3yrs (Not Potty Trained)3 - 5 yrs and Potty TrainedKindergarten1st Grade2nd Grade3rd Grade4th Grade5th GradeBirthday* Month Day Year Age*Allergies Child 7. Name* First Last Gender* Male Female Grade*Birth - 3yrs (Not Potty Trained)3 - 5 yrs and Potty TrainedKindergarten1st Grade2nd Grade3rd Grade4th Grade5th GradeBirthday* Month Day Year Age*Allergies Parent/GuardianYour Name* First Last Your Address Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Your Phone for Texting*Other PhoneYour Email Address* Are you a Member of McConnell? Yes No Who is Checking in the Child(ren)Today? Relationship to Child Emergency Contact Name and Phone # Who else can pick your child up? (must be over 18 years old, or "letter on file" is required)Is there anyone who is NOT allowed to pickup your child? Yes No Who? May we have permission to photograph your child?* Yes No May we use your child's photo in church media?* Yes No Child Protection & Safety Policy* I agree to the Child Protection & Safety Policy belowCHILD PROTECTION & SAFETY POLICY: In order to provide a safe and secure environment for preschoolers, children, youth and any person over the age of 18 with mental and/or developmental disabilities entrusted to our care, McConnell Baptist Church requires all individuals working with children and students (or other vulnerable populations) to complete online Child Protection & Safety Training though the Ministry Safe website & completion of a background investigation prior to starting ministry work or volunteer placements. This applies to all paid and non-paid church staff and volunteers who supervise or have custody of minors. Out of Control Behavior Addendum to Child Protection & Safety Policy McConnell Baptist Church staff and volunteers must take reasonable actions needed to protect all students from harm. Staff and volunteers may use reasonable physical restraints to break up a fight or other out of control behavior when any student becomes an imminent danger to themselves, or others, and the student(s) do not respond to less intensive interventions. Nothing herein prohibits a staff member or volunteer from defusing a fight or physical altercation.Your Comments, Questions or any special information about your child.
