Clubhouse Registration - GraceKids
Child's Name *
Your answer
Gender *
Child's Birthdate *
Your answer
What grade is your child? *
Parent/Guardian's Name *
Your answer
Address (street, city, state, zip code) *
Your answer
Contact Phone Numer *
Your answer
Emergency Contact and Phone Number *
Your answer
Who can pick up your child? Please also include their relationship to your child. *
Your answer
Does your child have any allergies? Please list below. *
Your answer
Does your child have any medical concerns that we should be aware of? Please list below. *
Your answer
I hearby grant permission for Grace Bible Church to record sounds, images, of my child while attending this program. I also give permission for Grace Bible Church at its sole discretion, to use these sounds, images, or videos in publications (including print websites, and social media platforms) owned by Grace Bible Church in relation to this program. *
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