2025-2026 Grace Space Registration
Register children ages 18-36 months to attend the Grace Space Montessori Atrium that runs during our church school time on Sundays (Participants must be accompanied by a parent, grandparent or guardian)
Parent/ Guardian Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent E-mail
*
example@example.com
Parent Mobile Number
*
Childs Name
First Name
Last Name
Gender
Birth Date
/
Month
/
Day
Year
Date
Allergies
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Consent to Use Photographs of Minors in Official Publications of Pohick Church
For the purpose of promoting its ministries, Pohick Church will often take photographs of children and staff, photographs in which children may be involved with others. In order to understand the wishes of parents and/or guardians with respect to the use of these photographs in official publications, this form must be completed and returned with your child's registration information. For clarity, the term "Pohick Church" as used herein refers to Pohick Church staff and volunteers; "photograph(s)" to both still photographs and videotape footage; "child" to a child who is a minor; and "official publications" to Pohick Church-sanctioned print publications, online publications, presentations, websites, and social media.
I understand that photographs of my child may be used in official publications. I also understand that no royalty, fee or other compensation shall become payable to me by reason of such use. I understand that no other personal identification of my child such as name, age, or grade, will be disclosed.
*
For official publications, I consent for Pohick Church to use photographs of my child taking part in church-sponsored activities and/or learning experiences.
For Official Publications, I DO NOT consent for Pohick Church to use photographs of my child taking part in church-sponsored activites and/or learning experiences.
Child(s) Name(s)
Parent/Gaurdian Name
First Name
Last Name
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