2021/2022 Zone56 Registration

Name:

Birthdate:

Age:

Grade:

Parent/Caregiver Name:

Address

This address will receive a confirmation email

home/cell phone

OK to text this number?

Yes No

Emergency Contact Name:

Emergency Contact Phone:

Allergies:

I give Koerner Heights Church permission to make visual images (photographs, movies, videos) and audio recordings of my child and to use such visual images and audio recordings on the koernerheights.org website, in printed or electronic marketing materials, in social media, or in other audio or visual communications, and I release Koerner Heights Church from any and all liability related thereto. Koerner Heights Church will keep any and all personal information regarding my child confidential and will not disclose or utilize it for any purposes other than Koerner Heights Church’s internal records and marketing purposes. PLEASE NOTIFY KOERNER HEIGHTS CHURCH IN WRITING IF YOU WOULD LIKE TO WITHHOLD YOUR PERMISSION FOR THE USE OF YOUR CHILD'S IMAGES.

Description

Zone56 begins on September 8, from 7:00 to 8:15 pm! Sign up now for a great time hanging with friends and exploring God's Word!
To register, fill out this form and click "submit"!

2021/2022 Zone56 Registration

Description

Please Fix the Following