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Midweek Registration
Register your student for Grace Church Midweek Activities for the 23-24 school year.
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* Indicates required question
Email
*
Your email
Name of Student
*
Your answer
Age of Student
*
Your answer
Student's Date of Birth
*
MM
/
DD
/
YYYY
Grade Student is in for the 22-23 school year
*
PreK - K
1st - 3rd
4th - 6th
7th - 8th
9th - 12th
Parent(s)/Guardian
*
Your answer
Home Address
*
Your answer
Parent email:
*
Your answer
Primary Phone Number (the number we call in case of an emergency)
*
Your answer
Secondary Phone Number (the number we call in case of an emergency and the primary phone number doesn't answer)
*
Your answer
Please list any allergies or medical issues the student has:
*
Your answer
The following person(s) has my permission to transport my child to and/or from all Midweek Study Activities:
*
Your answer
Signature:
*
Your answer
Date:
*
MM
/
DD
/
YYYY
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