Child's Name *
Child's Name
Birthdate *
Parent/Guardian Information
Parent/Guardian Name *
Parent/Guardian Name
Parent/Guardian Name
Parent/Guardian Name
Mobile Phone (Text Updates & Alerts) *
Mobile Phone (Text Updates & Alerts)
TEXT CONSENT: I consent to receive text updates related to Impact/KidBlast closings, emergencies, and/or ministry information. *
If different from above
Medical Information
If parent/guardian can not be reached
Emergency Contact Phone *
Emergency Contact Phone
MEDICAL CONSENT: In case of medical emergency, I understand that hospital policy requires parental permission before treatment. Checking the "Yes" button below is my digital signature giving my permission to a representative of CrossWay Church to secure proper medical treatment and/or administer medication as needed for my child. I understand a parent/guardian will be notified immediately of any medical emergency. *
PHOTO CONSENT: Unless expressly denied, CrossWay has default permission to use any participating child's images in any photographs/videos it may publish at any time. By marking "No" below, I am denying CrossWay Church permission to use my child's image. *