Kidz Club 22-23 Registration
Grace Community Church - Howard City
Child's Name
First Name
Last Name
Child's Age
Child's Grade Level for the 22-23 School Year:
Preschool
Kindergarten
1st
2nd
3rd
4th
5th
How did you hear about Kidz Club at Grace?
Attend Grace Community
Invited by someone who attends Grace Community
Facebook
Other
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent 1
First Name
Last Name
Parent 1 Phone Number
Please enter a valid phone number.
Parent 2
First Name
Last Name
Parent 2 Phone Number
Please enter a valid phone number.
Emergency Contact Name
First Name
Last Name
Emergency Contact Phone Number
Please enter a valid phone number.
Please list any allergies and/or other medical concerns our staff should be aware of.
Submit
Should be Empty: