Wednesday Kidz Club


Kidz Club 2017-2018

Here are some details you should know!

Fee: $10 per child - Payable first night (Books & shirts will be given out once paid)

Scholarships are available.

Kidz Club meets Weds nights 6:30 - 7:45pm

9/13/17 - 11/8/17 then break for Christmas

1/9/18 - 5/2/18 then break for Summer

(You do not have to pay again in January)

Family Info



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Child 1 Gender

Child 1 Age/Grade in Fall 2017

Child 2 Gender

Child 2 Age/Grade in Fall 2017

Child 3 Gender

Child 3 Age/Grade in Fall 2017

Child 4 Gender

Child 4 Age/Grade in Fall 2017

We could not make Kidz Club happen without parents!

We ask that parents whose children attend Kidz Club to please volunteer.

I am available to assist:*

If monthly, which week of the month do you prefer to help?*

Please check all that apply to your child/children:


I do hereby agree to hold harmless from indemnity, and defend against, including the payment of attorney’s fees, and costs, Washington Heights Church, its trustees, ministers, officers, and volunteers, including volunteers pertaining to Kidz Club. Including any and all claims, liability, allegations of personal injury, sickness, or death,
as well as property damages and expenses, of any nature whatsoever that may be incurred by the undersigned and/or child participant that may occur while said child is
participating in Kidz Club.  Furthermore, we on behalf of said child assume all risk of personal injury, sickness, death, damage and expense to him/her and/or other persons caused by my child as a result of participation in the recreation activities involved herein.  Should emergency treatment be necessary I authorize the KIDZ Crossing Director to act on my behalf and approve appropriate treatment.  We will call the
student’s parents/guardians as soon as possible for further instructions.  I also understand that pictures and video will be taken throughout the year and I grant permission for photos and video of my child to be used for Kidz Club promotion.


I have read the stated medical & photo/media release waiver:*

Please type first and last name as a signature agreeing to all the provided information above including the permission, medical release, and photo/video use permission waiver.