Grace Community Church - TeamKID Online Registration 2025-26

Student Name

Sex

Male Female

Student's Birthdate

Grade

potty trained pre K Kindergarten First Second Third Fourth Fifth

Parents/Guardians Name

This address will receive a confirmation email

Phone

Address

Home Church (if any)

Alternate contact's name

Alternate contact's phone number

Individuals authorized to pick up the student

Student's doctor/contact number

Tetanus current (7 years)

Yes No

Specific allergies, illnesses or other conditions?

To whom it may concern: As a parent and/or legal guardian, I do hereby authorize the treatment by a qualified and licensed medical doctor of the above minor in the event of a medical emergency which, in the opinion of the attending physician, may endanger his or her life, and/or cause disfigurement, physical impairment, or undue discomfort if delayed. This authority is granted only after a reasonable effort has been made to contact me. This release form is completed and signed of my own free will with the sole purpose of authorizing medical treatment under emergency circumstances in my absence. By checking yes in the box provided, I am giving medical consent for my child to be treated if needed.

Yes

Payment

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Grace Community Church - TeamKID Online Registration 2025-26

Description

Please Fix the Following