Women's Ministry - Kids Kare Registration
 
Women's Ministry - Kids Kare Registration
PLEASE NOTE: SMCC child care is provided for those registered for a specific Bible study, group or event. We know you appreciate this, and ask that you also serve: Weekly groups, serve twice a year and every-other-week groups serve once a year. Thank you SO much for being a part of our SMCC child care.
Your Email Address  * 
Please select "Yes" for the events that you will need childcare for.
The Amazing Collection Bible Study (Wednesday)  * 
Women of Joy PM Bible Study (Wednesday)  * 
Women of Joy AM Bible Study (Thursday)  * 
Mom Life  * 
Thursday AM Precept Bible Study  * 
Single Moms Event  * 
Military Wives Event  * 
Any Special Instructions for Children Registered
Dad's First and Last Name
Mom's First and Last Name
First and Last Name of other Responsible Adult (if not parent)
The above individual is
Children's Street Address  * 
City, State, Zip  * 
Cell Phone  * 
Home Phone
Other adults who can pick child(ren) up
Release and Consent for use of Photographs (Optional)
I (signed below) hereby consent and grant Shadow Mountain Community Church, Inc. (“SMCC”) the right to use my or my child’s photograph, picture, name or likeness taken via disc, digital storage device, videotape, or any electronic media for informational purposes and to advertise, promote and publicize SMCC. I also give SMCC the irrevocable right to copyright, use, publish, exhibit and distribute all or any portions of the above referenced. I understand that any SMCC taken photograph, picture, name or likeness of me or my child remains the sole and exclusive property of SMCC as well as all of the results and proceeds of any SMCC taken photograph, picture, name or likeness of me or my child. I and my child release any and all rights to entitlement of any of the above referenced. This release is binding on me, my heirs, assigns and attorneys. (Your "Yes" answer and your name typed below indicates that you are digitally signing this agreement.)  * 
Name
Child(ren)'s Information
Child #1
First and Last Name  * 
Birthdate  * 
Gender  * 
Age  * 
Grade  * 
Notes (Allergies, special needs, concerns, etc.)
Child #2
First and Last Name
Birthdate
Gender
Age
Grade
Notes (Allergies, special needs, concerns, etc.)
Child #3
First and Last Name
Birthdate
Gender
Age
Grade
Notes (Allergies, special needs, concerns, etc.)
Child #4
First and Last Name
Birthdate
Gender
Age
Grade
Notes (Allergies, special needs, concerns, etc.)
Child #5
First and Last Name
Birthdate
Gender
Age
Grade
Notes (Allergies, special needs, concerns, etc.)
Other Children
If you have more than five children, please enter the remaining children's information below.
 
 
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