Registration Form - Children's Ministries

GRACE KIDS - Registration Form 2024/25
Parents/Legal Guardians registering a child for a special event will be expected to complete a special event form in addition to this one.
Student's Name*

First NameLast Name
Sex*

MaleFemale
Birth Date*

MonthDayYear
Grade (Sept 2024)*
Parent/Guardian Name*

First NameLast Name
Email
example@example.com
Would you like to be on our parent monthly email list

YesNo
Parent Guardian Cell Ph #*

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Emergency Contact Name*

First NameLast Name
Emergency Contact Ph #*

Area CodePhone Number
Relationship to child*
In the case of custody agreements, please submit the proper form authorizing parental contacts.
Provincial Health Insurance Number of Student 9 digit*
Provincial Health Insurance Number of Student 6 digit*
Family Doctor*
Does your child have any allergies and or physical, emotional, mental, behavioural concerns or limitations that our staff should be aware of ?*

NoYesOther
Does your child take any regular medication that we should be aware of? *

NoYesOther
Bus Permission

If your child needs transportation on Kids Club nights please fill out this section. All parents/ designated guardians need to drop off and pick up kids at the bus
I ___________________________ give permission for my child listed above, To be picked up and dropped off by a Grace Community Church representative Tuesdays for Kid’s Club

First NameLast Name
Please list other adults authorized to pick up your child:

First NameLast Name
First NameLast Name
Medical Consent
The safety of your child is our primary concern. Precautions will be taken for their wellbeing and protection. I/we, the parents or legal guardians named on this form, authorize Grace Community Church’s Staff or Ministry Personnel to call Emergency Medical Services (911), sign a consent for emergency medical treatment and to authorize any physician or hospital to provide emergency medical assessment, treatment or procedures for the participant named on this form. Any costs incurred will be the responsibility of the parent/legal guardian. I/we, named on this form, undertake and agree to indemnify and hold blameless the Staff of Grace Community Church, its Ministry Personnel and Board of Deacons from and against any loss, damage or injury suffered by the participant as a result of being part of the activities of Grace Community Church, as well as of any emergency medical treatment authorized by the supervising individuals representing Grace Community Church. This consent and authorization is effective only when participating in or traveling to and/or from events of Grace Community Church. Do you agree to the above terms?*

Yes
Do you grant permission for future reasonable & safe use of pictures/video containing your child in the following ways: brochures/promotional material , displays/crafts, Grace Community Church website and/or newsletters?*

NoYes
I give my child permission to attend

Kids Club (Tuesday Nights)Grace Space (Sunday mornings
Please Sign here
Parent/Guardian Signature*
Should be Empty:

GRACE KIDS - Registration Form 2024/25

Bus Permission

Please Sign here