Words of Witness REGISTRATION
Sundays, 5-7 pm
Grace Baptist Church
3930 Aggie Road Jonesboro, AR            
ph. 870.935.1174
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Email *
Student's Name *
Did child attend last year?
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Boy/Girl *
Grade level this school year *
Street Address *
City *
State *
Zip Code *
Mailing address if different from street address
Date of Birth *
MM
/
DD
/
YYYY
Brothers or Sisters attending WOW
Dietary restrictions/Medical Conditions *
Parent's/Guardian's Name *
Phone number *
Emergency Contact Name, Phone #, and Relation to child *
Person other than parent authorized to pick up your child
Any special circumstances that our staff needs to be aware of?
By registering your child, you give the church permission to photograph and share pictures on social media. You release and hold harmless the trustees, officers, employees and any volunteers of Grace Baptist Church from any liability, past or future, fully and completely. You authorize the staff or designated medical professionals and/or volunteers to administer emergency medical assistance if you cannot be reached.
I have read the above paragraph and I agree. *
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