Duluth House of Refuge - Kids Ministry Child Sign-up

House of Refuge Kids Ministry Child Sign-up Form

To better care for your family, please complete the following information.
Thank you!

First Name

Last Name

Relationship to Child(ren)

Email

Phone Number

Mailing Address

Apartment, suite, etc.

City

State

Zip/Postal Code

First Name

Last Name

Birthdate

Gender

Grade

Allergies

Any Special Requests:

Releases and Signature

Photo Release: My child's photo may be used for internal and publication purposes.

Yes

No

Release: I give my child permission to participate in House of Refuge church activities. I understand that my child will not be released to any unauthorized person(s). I also understand that House of Refuge church will not be held liable for any damages or injuries that may be sustained.

Yes

No

Signature