GROW 3:18 REGISTRATION FORM
Parents Name *
Parents Name
Email *
Address *
Preferred Phone Number *
Emergency Contact
Emergency Contact Phone #
Others with permission to pick children up: Siblings must be 6th grade or older
Child's Name *
2019-2020 Grade *
Age *
Birthday *
MM
/
DD
/
YYYY
Allergies Concerns- Write none if there are none *
Child 2 Name
2019-2020 Grade
Clear selection
Birthday
MM
/
DD
/
YYYY
Age
Allergies Concerns- Write none if there are none
Child 3 Name
2019-2020 Grade
Clear selection
Birthday
MM
/
DD
/
YYYY
Age
Allergies Concerns- Write none if there are none
Child 4 Name
2019-2020 Grade
Clear selection
Birthday
MM
/
DD
/
YYYY
Age
Allergies Concerns- Write none if there are none
Please indicate which areas you might be willing to serve in:
Permission to Photograph
We would like to use group photos of your child in our monthly publications, website and Facebook. Names would not be used to identify the children. Please sign below to show that we have your permission.
Yes or No *
Signature *
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