REGISTRATION FORM Child's Name* First Last Child's Grade* K5 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade Not in school (Please state age) Child's Birthdate MM slash DD slash YYYY Parent/Guardian's Name* First Last Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone NumberEmail* Who is authorized to pick up your child? (Must be at least 18 years old)Any allergies, special needs, or extra information? Registered By:* First Last I hereby give consent for Grace Church to use on their website or in print media all photographs in which I/my child appear(s) while involved in the ministries of Grace Church.* Yes No Questions or Comments
