Graffiti Kids VIRTUAL Fall Program Registration 2020

Graffiti Kids VIRTUAL Fall Program Registration 2020
We are excited you are joining us for

Graffiti Kids Virtual Fall Program 2020!

Open to kinder-5th grade students.

Weekly Wed. Zoom: Program will take place each Wednesday, from October 28-November 18, 2020 (4 weeks). We will have a virtual Bible study, fun, & game sessions via Zoom from 4:00-4:40 pm. A link will be sent to you upon completion of this registration form.

Monthly Fun Kits: In addition, we will have a special Grab-&-Go Fun Kit day each month (October 29, November 19, & December TBD) where you can stop by Graffiti Church (205 E. 7th St.) to pick up a fun kit between 4:30 pm and 5:30 pm. Kits will contain things like themed crafts, snacks, coloring/activity sheets, small toys, etc. More info to come! Note: These kits are just for fun and are not needed for participation in the Wednesday Zoom sessions. (Masks and social distancing required for pick up.)

This fall, we are providing this virtual program at no cost to you.
Child Information
Child's Name *

First Name Last Name
Birth Date *

Month Day Year
Grade *
My child is participating in the following: *

Remote Instruction Blended Learning
Gender *

Male Female
Add Child?

Yes
Child (2) Name *

First Name Last Name
Child (2) Birth Date *

Month Day Year
Child (2) Grade *
My child (2) is participating in the following: *

Remote Instruction Blended Learning
Child (2) Gender *

Male Female
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Parent/Guardian Information
Name *

First Name Last Name
Cell Number *

Area Code Phone Number
E-mail *
We are happy to provide this service. Since this is a virtual communication, we are unable to monitor the children's activities. Please continue to monitor your children's activities at all times and ensure that they are being safe and have a safe place to participate. Please also be aware that although we will not tolerate inappropriate behavior, we are relying on parents to ensure that children are not presenting inappropriate things on the camera or on screen sharing.

I, the parent or guardian of the above-named child, give my permission, voluntarily and without compensation or time restrictions, for the use of any visual/audio images of my child and his/her name in broadcasts, telecasts, publicity, websites, or written accounts of any Graffiti Community Ministries, Inc. event, without notification to me or my child. I agree that Graffiti Community Ministries, Inc. owns such visual/audio images and all rights related to such images with full power of disposition for non-profit purposes.

I, the parent or guaridan, understand that Graffiti Community Minisries, Inc. is a Christian organization; therefore, Christian values and Bible stories will be taught and upheld as part of virtual fall program activities.
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
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