YES NO(Please Circle One)

YES NO(Please Circle One)

2017 Release Form & Questionnaire

Family Name:

Child 1 Name:DOB:

  1. Is your child toilet-trained?YESYES, but has accidentsNO(Please circle one)
  1. Does a Kidshine volunteer have permission to change your child’s diaper if necessary?

YES NO(Please circle one)

  1. If your child is inconsolable, you desire for a KidShine volunteer to contact you via the text messaging system or to bring your child up to the sanctuary? YES NO(Please circle one)
  1. Do we have permission to take picture of your child at KidShine to use for the church website, newsletter, Facebook, Twitter, or other social media outlets? YES NO(Please circle one)

Child 2 Name:DOB:

  1. Is your child toilet-trained?YESYES, but has accidentsNO(Please circle one)
  1. Does a Kidshine volunteer have permission to change your child’s diaper if necessary?

YES NO(Please circle one)

  1. If your child is inconsolable, you desire for a KidShine volunteer to contact you via the text messaging system or to bring your child up to the sanctuary? YES NO(Please circle one)
  1. Do we have permission to take picture of your child at KidShine to use for the church website, newsletter, Facebook, Twitter, or other social media outlets? YES NO(Please circle one)

Child 3 Name:DOB:

  1. Is your child toilet-trained?YESYES, but has accidentsNO(Please circle one)
  1. Does a Kidshine volunteer have permission to change your child’s diaper if necessary?

YES NO(Please circle one)

  1. If your child is inconsolable, you desire for a KidShine volunteer to contact you via the text messaging system or to bring your child up to the sanctuary? YES NO(Please circle one)
  1. Do we have permission to take picture of your child at KidShine to use for the church website, newsletter, Facebook, Twitter, or other social media outlets? YES NO(Please circle one)

Parent/Guardian Signature:Date:

*All KidShine Volunteers are over the age of 18 and have current criminal background checks. There will always be at least two adults assisting with the KidShine program for both services. On some weeks there may be, in addition to the two adults, a youth or two (under the age of 18) who are helping the two adults with a lesson, preparing snacks, etc.

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