Grace Kids Capitol Hill Family Check-In Form 
We are excited that your child/children will be joining us for grace kids service. Please complete this form for all children. Please stop by our Family Check-In area for assistance with printing out your child's security tag.  

If you have any questions or concerns, or would like to share any additional information about your child, please reach out to our grace kids coordinator, Jessica Jocelyn at gracekidsch@gracecov.org
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Parent/Guardian Name *
Child’s Name *
Date of Birth  *
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/
DD
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YYYY
Age *
Gender *
Required
Best Contact Number (During Service) *
Email Address *
Mailing Address
Are there any special considerations that we need to be aware of? (allergies, learning style, diagnoses, etc.) *
Child’s Name #2
Date of Birth 
MM
/
DD
/
YYYY
Age
Gender
Are there any special considerations that we need to be aware of? (allergies, learning style, diagnoses, etc.)
Child’s Name #3
Date of Birth 
MM
/
DD
/
YYYY
Age
Gender
Are there any special considerations that we need to be aware of? (allergies, learning style, diagnoses, etc.)
Child’s Name #4
Date of Birth 
MM
/
DD
/
YYYY
Age
Gender
Are there any special considerations that we need to be aware of? (allergies, learning style, diagnoses, etc.)
Add any additional children below. Include full name, DOB,  age, and special considerations. 
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