2018 Camp Grace Registration
Child's Name *
Your answer
Birthday *
MM
/
DD
/
YYYY
Address *
Your answer
School Grade (Fall 2018) *
To keep your child as safe as possible, please fill out the applicable information:
My child has the following conditions that may require medical intervention, please list condition followed by type of intervention necessary (epi pen, inhaler, etc.) *
Your answer
My child has the following physical limitations *
Your answer
Parent Contact Information
Parent #1: Name *
Your answer
Parent #1: Phone *
Your answer
Parent #2: Name
Your answer
Parent #2: Phone
Your answer
Emergency Contact Information
If parent is unavailable
Emergency: Name *
Your answer
Emergency: Phone *
Your answer
Hospital/Doctor Preference *
Your answer
By participating in Camp Grace, you understand that photos of your child may be posted to our Facebook, Instagram, and/or website.

If you see any image of your child that you wish not to be used on one of these platforms, please contact grace@gracemahomet.org and let us know which photo you would like removed and we will take the photo down. Please include your name and contact info, so we can reach you if we have trouble locating the photo.

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