Destiny Kids Time Registration

Please complete all relevant information. If you have any questions or comments, you can provide them in the comments section at the bottom of this form or call the church at 952-890-1477 and ask for Kari Langham.

Child's Information

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Parent/Guardian Information

Mother's Information (or Guardian)

Father's Information (or Guardian)


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Registration Information

Release Authorization

Below please list the names of the persons authorized to pickup your child. Your child will not be released to others without your permission. You may also authorize an individual for a particular day by placing their name on the daily sign‐in sheet. Please advise designated persons to have proper identification available. If an emergency arises you can call the Destiny Church office at (952) 890-1477 and give verbal permission to release your child to an individual.

Medical Authorization

Medical Treatment Agreement: In case of an accident or illness, if I (we), the parent(s) or guardian(s), are not available, my (our) child should receive medical treatment by Destiny personnel, by his/her doctor, or by personnel of a hospital emergency room.

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Permission to Administer

I hereby give Destiny Kids Time permission to administer the following products according to the manufacturer's instructions or otherwise specified.

NOTE: Destiny Kids Time worker will use his/her best judgement as situations arise, and if in doubt, he/she will call for verification.

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Message Us

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