An Afternoon of Fun Registration
Event Timing: July 15, 2017, 1:30-3:30 PM
Event Address: Grace Lutheran Church, 1212 9th Ave N, Edmonds, WA 98020
Contact us at 425.640.3692
Email address *
Child's Name *
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Age *
Parent Name *
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Phone *
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Please send me information about upcoming events at Grace Lutheran Church
Consent and Release *
My Child has my permission to attend Grace Lutheran Church’s An Afternoon of Fun on July 15, 2017. I release Grace Lutheran Church and all adult chaperones who are in attendance from any liability for injury to my child, unless such injury results from an intentional act by said adult. I further give adult chaperones the authority to administer or arrange any emergency medical attention for my child if I am not available. I also give permission for my child to be photographed/videotaped during all activities of Grace Lutheran Church and authorize the use of said photographs/video for publicity purposes of Grace Lutheran Church.
Emergency Contact
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Primary Phone
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Other Phone
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Allergies, medicines, other medial information:
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