Kids Club Registration Form

Please complete this form for the '26/‘27 Kids Club year. This will help us ensure that we have the most up to date contact information or any medical issues for your child.

Child's Name (1) First & Last

Birthdate

Gender

*

Please select all that apply.

Male Female Other

Current Grade

Please select all that apply.

Nursery/Toddler K 1st 2nd 3rd 4th 5th

Child's Name (2) First & Last

Birthdate

Gender

*

Please select all that apply.

Male Female Other

Current Grade

Please select all that apply.

Nursery/Toddler K 1st 2nd 3rd 4th 5th

Child's Name (3) First & Last

Birthdate

Gender

*

Please select all that apply.

Male Female Other

Current Grade

Please select all that apply.

Nursery/Todler K 1st 2nd 3rd 4th 5th

Child's Name (4) First & Last

Birthdate

Gender

*

Please select all that apply.

Male Female Other

Current Grade

Please select all that apply.

Nursery/Toddler K 1st 2nd 3rd 4th 5th

Address

*

Parent 1 Name (First & Last)

*

Parent 1 Phone

*

Email

*

This address will receive a confirmation email

Parent 2 Name (First & Last)

Parent 2 Phone

Email

Medical Information & History

Allergies

*Promotional Consent: I agree to allow my child(ren)'s image to be used by Ojai Presbyterian Church for promotional use. These may include pictures used in our church newsletter, flyers, videos, or the church website and socials. Children will not be identified by name unless a specific request is made and authorized by the parent or guardian.

*

Please select all that apply.

Yes No

Electronic Signature*

*

*By entering my name in the box above, I am providing my digital signature on this Form.

Unnamed Label

Please select all that apply.

Description

Please complete this form for the '26/‘27 Kids Club year. This will help us ensure that we have the most up to date contact information or any medical issues for your child.

Please Fix the Following

Close