Gracepoint Youth Student Waiver / Information Form
This form is for students participating in activities with Gracepoint Community Church.
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Student Information
Full Name *
Age *
Birthday *
Grade *
School Attending *
Student Email *
Address (include city, postal code) *
Primary Phone *
Secondary Phone
Parent/Guardian Information
Name(s) *
Email *
Primary Phone *
Secondary Phone
Emergency Contact
Name *
Phone *
Medical History
Please describe in detail the nature and severity of any physical and/or psychological ailment, illness, propensity, weakness, limitation, handicap, disability, or condition to which the student is subject and of which the staff/volunteers should be aware, and what, if any action of protection is required on account thereof.
Please list any relevant medical conditions the student suffers from
Additional Comments/Information
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