Kidz Corner Registration Form – Silicon Valley Alliance Church

2020 Kidz Corner Winter Registration

Date: Jan 14, 28, Feb 11, 25, Mar 10, 24, Apr 7, 28, May 12, 2020 (9 sessions)
Time: 9:30am to 11am
Location: Silicon Valley Alliance Church (10 Dempsey Road, Milpitas, CA 95035)

Who can attend: 6 months - 5 years old (accompanied by parents or guardians)
Registration Fee: $45/child. Due to limited availability, it is first come, first served. If you have multiple children to register, please do one child at a time and repeat the registration process.

IMPORTANT: Registration fee is not refundable. You'll need to pay the fee via PayPal. If you prefer to pay by cash or check, you need to contact us at kidzcorner@svac-cma.org after registering your child. Registration is complete until we receive the payment.

Child's Information

Child Participant's Name:*

First

Last

Child's Age*

Gender:*

Boy

Girl

Adult Participant's Information

Adult Participant's Name*

First

Last

Relationship to the child:*

Address:*

Street AddressCityState / Province / RegionPostal / Zip CodeCountry

Phone Number:*

Area Code

Phone Number

E-mail:*

Any medical conditions: (If none, enter none below.)*

Would you like us to contact you for the future programs/activities?

Yes, please do contact us.

Release of Liability

I, the undersigned, parents/guardians of the above named child do agree to release and hold Silicon Valley Alliance Church (SVAC) and its staff and volunteers harmless from any claim, demand or cause of action for injury to the above named participant of SVAC’s Kidz Corner programs or damage to his or her personal property which arises out of or is in any way connected with the programs of SVAC. SVAC will not be responsible in case of accident, illness or property damage. I also authorize SVAC to put my child under the treatment when my child is in medical need. I also agree that my child be treated by any licensed physician. I also understand SVAC may photograph or videotape the events or activities in which I am (or my child is) participating. I give my permission for SVAC to use photographs or videotape of me (or my child) for the purpose of promoting its services/programs. I give my permission with the following understanding: No compensation of any kind will be paid to me (or my child) at the time or in the future for the use of my (or my child’s) likeness, i.e. your child's name on the video.

I agree to the terms of the release of liability*

Yes

Please type your name below as the signature*

Click SUBMIT button below to pay the registration fee via PayPal

PAY BY PAYPAL: Simply click "Submit" button and it will take you to PayPal site to finish your payment. A email will be sent to you to confirm your registration.

Silicon Valley Alliance Church is committed to protecting your privacy and does not share your personal information with third parties. For further information, see Silicon Valley Alliance Church Privacy Policy.

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