Registration for Children's / Youth Christian Formation
Thank you for registering your child for Children's/ Youth Christian Formation programming at Grace!
Basic Information
First name of child *
Your answer
Last name of child *
Your answer
Birthdate *
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Grade in school in 2018-19 *
Date of baptism
If your child has been baptized, please provide date and where. If you don't know the exact date, please use 1 for the day.
MM
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DD
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YYYY
Place of Baptism
Your answer
Name of parent / guardian 1 *
Your answer
Email address for parent / guardian 1 *
Your answer
Best phone number to reach you *
Your answer
Name of parent / guardian 2
Your answer
Email address for parent / guardian 2
Your answer
Best phone number to reach you
Your answer
Street address *
Your answer
City *
Your answer
State *
Your answer
Zip code *
Your answer
Main phone *
Your answer
Which Sunday service do you most often attend?
Where are you likely to be when your child is in Grace formation programs (e.g., choir practice, adult formation, out of the building)? *
Your answer
Please list at least one emergency contact person (name and number) should we be unable to reach you. *
Your answer
Medical & Emergency Information
Does your child have any medical condition (e.g. asthma, epilepsy) or exceptionality (e.g. learning disability, ADD) we should be aware of?
We often eat food together. Please list all food allergies and their severity. Does your child need an EpiPen on or near them?
Your answer
Medical insurance company under which child is covered *
Your answer
Insurance Policy Number *
Your answer
What else would you like us to know about your child?
Your answer
Release & Permissions
The undersigned parent or legal guardian of the above-named child, a minor, does hereby grant permission for the said child to engage in the various activities sponsored by Grace Episcopal Church for its Formation Programs, including, but not limited to, travel in automobiles, attendance at related group activities, and general participation in any and all activities sponsored by or associated with Grace’s Youth. *
Required
I understand that my child may be photographed or videotaped from time to time in relation to formation and general social activities of Grace Church, and I hereby grant my permission to allow my child to be videotaped and/or photographed in this manner, and grant to Grace Episcopal Church the right to publish, copyright or use these images as it sees fit, with the understanding that per Grace and diocesan policy, no minor in any photograph will be identified by name. *
Required
I understand that my child may be photographed or videotaped from time to time during a worship service at Grace Church, and I hereby grant my permission to allow my child to be videotaped and/or photographed in this manner, and grant to Grace Episcopal Church the right to publish, copyright or use these images as it sees fit, with the understanding that per Grace and diocesan policy, no minor in any photograph will be identified by name. *
Required
This consent also includes specific permission hereby granted to the adult supervisors and leaders of Grace’s Youth to make medical decisions with respect to the said minor child in the event of accident or injury when parental consent shall be unavailable or when circumstances shall require immediate medical decision, and to administer medication when required. *
Required
Other Ministries
Children and youth are an important part of the Grace community and we value their presence in all aspects of worship and community life. Which Grace ministries might your child be interested in learning more about?
Which Grace ministries might you be interested in learning more about?
Children and Youth Formation programs at Grace are free and entirely volunteer-led. Because of this, we ask that all parents/guardians stay involved by lending their time and talents to helping their child's programs (or other program!) succeed. How can you help us this year? *
Required
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