Register for Wednesday Night Kids

Parent/Guardian Information

Registration

At Wednesday Night Kids, we charge $25 per kid for the year, with a max cost of $75 per family.   Open the appropriate link in a separate tab to complete your payment and continue with the rest of this registration form.

I would like to register 1 child for $25.  Click here.
I would like to register 2 children for $50.  Click here.
I would like to register my family (3 or more kids) for $75.  Click here.

Child #1 Information 

Child #2 Information 

Child #3 Information 

Child #4 Information 

Child #5 Information 

Hold Harmless Agreement

I understand that participation in the activity involves a certain degree of risk. I have carefully considered the risk involved and  have given consent for myself or my child to participate in the activity. I understand that participation in the activity is entirely  voluntary and requires participants to abide by applicable rules and standards of conduct. I release Cottonwood Community Church, the activity coordinators, and all volunteers, related parties, or other organizations associated with the activity from any  and all claims or liability arising out of this participation. In case of an emergency involving my child, I understand every effort will be  made to contact me. In the event I cannot be reached, I hereby give my permission to the medical provider selected by the adult  leader in charge to secure proper treatment, including hospitalization, anesthesia, surgery, or injections of medication for my child.  Medical providers are authorized to disclose to the adult in charge examination findings, test results, and treatment provided for  purposes of medical evaluation of the participant, follow-up and communication with the participant’s parents or guardian, and/or  determination of the participant’s ability to continue in the program activities.

Other Consent Agreements

I, (we), authorize pictures, information, and images of the above named minor(s) to be placed on the Cottonwood  Community Church website, (www.cottonwoodcommunity.org)

I, (we) understand that if my child(ren) does not adhere to the rules of the program, he/she may be required to not attend a night without refund. I (we) further understand that if my child(ren) does not adhere to the rules, I will receive a visit or phone call from the Director to discuss my child(ren)’s further involvement.

THIS FORM WILL SERVE AS MEDICAL INFORMATION AND PERMISSION FORM TO COVER ALL ACTIVITIES THROUGHOUT THE 24-25 YEAR. PLEASE NOTIFY STAFF IN WRITING OF ANY CHANGES.