grace kids Honesdale (Spring 2019)

grace kids Honesdale Spring 2019 | Please fill out this form and click submit.

Child Name

*

Child Grade

*

Please select one option.

K 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade

Parent Name

*

If your child has previously participated in programs at The Vineyard Center, and if you have no changes at all to the requested info below, please check the appropriate box. If your child has not previously attended our programs in the past, please complete all areas of this form. Thank you.

Please select all that apply.

I have no changes. All info is the same. Please use the updated information as listed below.

Email

This address will receive a confirmation email

Address

Cell Phone #

Alternate Contact #

Emergency Contact Name

Emergency Contact Number

Does child have any allergies or health concerns?

Please select one option.

None Yes, Note info below

Additional Allergy Info:

Riding bus from school?

Please select one option.

Yes No

I give authorization to grace ridge church to photograph and release such photographs of my child for the purpose of public information and publicity in the interest of grace ridge church.

Please select all that apply.

Yes No

Description

grace kids Honesdale Spring 2019

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