Grace Hill Church - Child Online Registration - 2018
Email address *
Parent(s) First & Last Names *
Your answer
Child's Name (#1) *
Your answer
Birthdate *
Your answer
Grade *
Child's Name (#2)
Your answer
Birthdate
Your answer
Grade
Child's Name (#3)
Your answer
Birthdate
Your answer
Grade
Child's Name (#4)
Your answer
Birthdate
Your answer
Grade
Phone Number (best # to reach you) *
Your answer
Alternate Phone Number
Your answer
Address *
Your answer
E-mail Address *
Your answer
If you were invited by someone, who invited you?
Your answer
If your family regularly attends church, where do you attend?
Your answer
Grace Hill Church would like to take photographs/videos of children during Children's/Youth Ministry activities to use in a lawful purpose, such purposes as sharing on the GHC social media page, website and sharing within the church body. Names of children will not be shared. *
My child may be transported to/from church by...
Your answer
Emergency Contact (other than parent) *
Your answer
Emergency Contact Primary Phone Number *
Your answer
Emergency Contact Secondary Phone Number
Your answer
Medical Release Information *
Doctor's Name(s)
Your answer
Doctor's Phone Number
Your answer
Allergies? Please list child's name and any allergies.
Your answer
Any additional information or special needs?
Your answer
In case of a medical emergency, I hereby give Grace Hill Church permission to secure proper treatment or hospitalization for the child(ren) on this registration form. *
*Your typed signature on this form gives us permission in case of emergency.
Your answer
Please note: Grace Hill Church will make every attempt to reach the parent(s)/guardian(s) or the emergency contact(s) given on your registration form.
If you have any special concerns regarding an emergency, please let us know.
Your answer
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