WEDNESDAY NIGHT PROGRAM AT 5:45PM

KIDS GRADES PRE-K TO 5TH

GRACE KIDS REGISTRATION

Child's Name

First Name

Last Name

Date of Birth (MM/DD/YYYY)

Child's Grade

Parent/Guardian Name

First Name

Last Name

Phone

(###)

###

####

Email

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Special / Medical Needs

Please Read Permissions

My child has permission to attend Grace Kids Wednesday Night by Grace Fellowship Evangelical Free Church (hereinafter "the church"). This consent form gives permission to seek whatever medical attention is deemed necessary and releases the church and its staff/leader of event, of any liability against personal losses of named child. This also gives Grace Fellowship permission to take and use photos of your child. I/we the undersigned have legal custody of the student named above, a minor, and have given consent for him/her to attend the event listed above. I/we understand that there are inherent risks involved in any ministry event, and I/we hereby release the church, its pastors, employees, agents, and volunteer workers from any and all liability for any injury, loss, or damage to person or property that may occur during the course of my/our child's involvement. Further, I/we affirm that the health insurance information provided above is accurate as of this date. I/we agree to bring my/our child home at my/our own expense should they become ill or if deemed necessary by the student ministries staff member.

Parent / Guardian Signature (Please type)