Dear Parents:
We are excited to have your child in our care! We strive for each child to feel comfortable, happy, loved, and secure. Our nursery team is selected for their experience and love of children and consists of both nursery staff and volunteers. The nursery staff bios are available on the bulletin board in between the classrooms, and each employee is CPR and First Aid certified. All of our volunteers have completed a background check and Ministry Safe training. Always feel free to contact us if we can be of assistance to you or your child.

Jennifer Kizziah,
Director of Kids Ministry

Please complete the form below before checking your child(ren) into our care for the first time & annually thereafter. We also have paper versions available in the classrooms. Thank you!

Click here to view our Parent Handbook

Primary Parent Contact Name

First Name

Last Name

Secondary Parent Contact Name

First Name

Last Name

Primary Parent Phone Number

(###)

###

####

Secondary Parent Phone Number

(###)

###

####

Primary Contact's Email

Secondary Contact's Email

Child(ren)'s Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Child's Name

First Name

Last Name

Child's Birthday

YYYY

Any Allergies or Special Needs?

Child's Grade

Child 2's Name

First Name

Last Name

Child 2's Birthday

YYYY

Any allergies or special needs?

Child 2's Grade

Child 3's Name

First Name

Last Name

Child 3's Birthday

YYYY

Any allergies or special needs?

Child 3's Grade

Child 4's Name

First Name

Last Name

Child 4's Birthday

YYYY

Any allergies or special needs?

Child 4's Grade

Medical Release

I am the parent or guardian having control or custody of the registered child(ren). I hereby grant my child(ren) permission to take part in the Westminster Presbyterian Church’s Kids Ministry Events from September 2020 - August 2021. I certify that my child is physically and mentally fit for these activities and will obey the rules and leaders in charge. I understand Westminster Presbyterian Church of Lubbock, TX will make every effort to contact me, or those named, in the case of an emergency. However, if unable to make contact, I grant permission in case of injury, accident, or illness for my child to be transported in an emergency vehicle or be treated by any licensed physician should the need arise, and I agree to pay for such treatment including any and all emergency transport and medical services fees and expenses.

Photo Release

If clicking ‘Yes’ below, I hereby grant Westminster Presbyterian Church of Lubbock, TX permission to use photographic portraits, pictures, digital images or video of my child(ren), in which my child(ren) may be included in whole or part for any lawful purpose including but not limited to printed publications, video presentations and/or online.

Yes, I grant permission

No, I do not grant permission

Would you like to be added to our KidsMin communications?

We send out weekly emails that have the upcoming highlights and remind texts for any of our programs or cancellations.

Yes, Please add me to the email blast

Yes, Please add me to the Remind text group