Kids Registration • Lighthouse to the Nations Church

Lighthouse Kids Registration

Please fill out ALL fields in full.

Parent/Guardian's Full Name *

I am this child's: *

Mother

Father

Legal Guardian

Friend's Parent

Parent/Guardian's Contact Number *

Other Emergency Contact Name & Number *

Which site do you currently attend? *

Edenvale Site

Orchards Site

Child's First Name *

Child's Last Name *

Child's Gender *

Child's Date of Birth *

School Grade *

Special Needs Child *

Does your child have any allergies? *

Do you consent to photographs being taken of this child (may be used in social media & on the webpage) *

Yes

Indemnity

I, the parent / guardian of the above mentioned child, together with my/our heirs, trustees, executors or assigns, hereby indemnify Lighthouse Kids and Lighthouse to the Nations Church, together with any Leaders, Deacons, Elders, volunteer workers and any staff associated with Lighthouse to the Nations Church, against any claim howsoever arising as a result of my child’s involvement with Lighthouse Kids or Lighthouse to the Nations Church.

Confirm Indemnity *

Yes

Tip: Please note that if you select "No" we will not be able to accommodate your child at Lighthouse Kids.

Medical Release

I understand that in the event of medical treatment being required for the above-mentioned child, every effort will be made to contact me or my other emergency contact. However, if we cannot be reached, I give my permission to the Leaders, Deacons, and Elders present to procure medical treatment, including anesthesia, for my child’s wellbeing.

Confirm Medical Release *

Yes

Tip: Please note that if you select "No" we will not be able to accommodate your child at Lighthouse Kids.