Disciple Now Registration 2020
Student Phone Number
Parent/Guardian Phone Number
Emergency Contact Name/Relationship/Number
Please initial if you agree to the following
I will allow my child to be treated with over the counter medications for minor illnesses such as headache, diarrhea, etc. (i.e., Tylenol, Pepto-Bismol, Aloe Vera, etc.)
My child has permission to self-medicate according to prescription guidelines for any prescriptions he/she may be taking.
I give my permission for videos or photos containing images of my child to be used for promotional purposes. I acknowledge that fees will not be paid for such use.
I will check my child’s temperature before sending him/her to D-Now and not allow him/her to attend if not feeling well.
Please list any known allergies, illnesses, or prescription medications your child has or uses below:
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This form was created inside of Grace Community Church.