Grace Kids Church School Registration Form
Student Information
Student Name
*
First Name
Last Name
Nickname/Preferred Name
Date of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Male
Female
Prefer Not To Say
Age
*
Grade
*
2nd Student Name
First Name
Last Name
Nickname/Preferred Name
Date of Birth
-
Month
-
Day
Year
Date
Gender
Male
Female
Prefer Not To Say
Age
Grade
Address for all students being registered
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Parent/Guardian Information
Parent Name
*
First Name
Last Name
Preferred Name
Relationship To Student
*
Please Select
Mother
Father
Aunt
Uncle
Grandparent
Other
Parent Email
*
example@example.com
Parent Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Alternate Parent Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Additional Parent
Additional Parent Name
*
First Name
Last Name
Preferred Name
Relationship To Student - Additional Parent
*
Please Select
Mother
Father
Aunt
Uncle
Grandparent
Other
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Emergency Contact Information
Emergency Contact Name
*
First Name
Last Name
Relationship To Student
*
Please Select
Mother
Father
Aunt
Uncle
Grandparent
Other
Emergency Contact Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Alternate Emergency Contact Number
Please enter a valid phone number.
Format: (000) 000-0000.
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Medical Information
Allergies
Medications
Special Needs or Conditions
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Church Information
Please ensure that all necessary church information is completed.
Are you a member of Grace Presbyterian Church?
*
Yes
No
If no, what church do you attend?
Would you like to receive information about Grace Presbyterian Church events and activities?
*
Yes
No
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Parental Consent
Please check all necessary parental consent fields.
By checking each statement below, I acknowledge the following:
Food Allergies
*
As part of the programming, my child may be exposed to or served snacks. I have accurately provided information regarding allergies and medical conditions and will update as necessary.
Photos
*
Photos of Grace Kids and Youth programs and activities may occasionally be taken as a part of sharing Grace's life and ministry together. These photos may be shared publicly during worship at Grace, in Grace's building, and through media such as Grace's bulletin, website, social media, and newsletter. Photos shared will be group photos only and names will not be shared.
Pick-up
*
Children grade 6 and under require a parent or guardian to pick them up promptly at the end of service.
Classroom Leave
*
I give consent for my children, Grades 5 and above, to leave the classroom upon completion of worship and class time.
Completion of Church Service
*
Upon completion of the worship service, I assume responsibility for my child or children.
Please list the names of those you permit to pick up your children.
First Name
Last Name
Please list the names of those you DO NOT permit to pick up your children.
First Name
Last Name
Registration information is collected for church records, statistics, and pastoral care by authorized church leaders and staff. It will not be used for other purposes. I confirm the above is accurate and understand my family’s privacy will be protected.
*
Please provide your signature by holding down the mouse button and moving the cursor, or using your finger on a touchscreen device.
Date
-
Month
-
Day
Year
Date
Submit
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