Grace Children and Family Ministries Enrollment Form

Grace Children & Family Ministries Enrollment Form

Nursery, Early Education, Elementary School Classes and Activities.
Student Name

First NameMiddle NameLast Name
Birth Date

MonthDayYear
Gender
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student E-mail
example@example.com
Mobile Number
Format: (000) 000-0000.
What School do you go to?
What grade are you in?
Parent 1 Name

First NameLast Name
Parent 1 Email
example@example.com
Parent 1 Mobile Number
Format: (000) 000-0000.
Parent 2 Name

First NameLast Name
Parent 2 Email
example@example.com
Parent 2 Mobile Phone
Format: (000) 000-0000.
Emergency Contact 1 Name

First NameLast Name
Emergency Contact 1 Mobile Number
Format: (000) 000-0000.
Emergency Contact 2 Name

First NameLast Name
Emergency Contact 2 Mobile Number
Format: (000) 000-0000.
List any Allergies
All types of allergies/emergency medical directives
Share anything we should know to better care for your child.
My child's photo

School photo style preferred
Cancelof
Grace Presbyterian Church sponsors various activities for children and youth. I give permission for my child to participate in any church-sponsored activity that my child attends. I understand that with any activity there is the chance of injury to person or damage to property. Notwithstanding that risk, I agree to hold harmless and indemnify Grace Presbyterian Church, its employees, representatives, and advisors against all liabilities, claims, suits or demands for injuries to any person and/or property arising from my child’s participation in a church-sponsored activity.
I understand that while participating in church activities my son/daughter may be included in photos or videos, such as live streaming in worship, classroom art activities or special events. The photos or video may be included in church publications, social media channels, web sites or App of Grace Presbyterian Church.
Signature of Parent or Guardian
Date

MonthDayYear
Date
Should be Empty:

Grace Children & Family Ministries Enrollment Form