Family Night Registration

Address *

Line 1

Line 2

City

State

Zip Code

Country

Additional Authorized Persons to pick up your child *

Email *

Phone Number *

Alt. Emergency Phone must be different than Main Phone Number

Alt. Emergency Phone # *

Emergency Contact Name *

First

Last

Relationship to the Child: *

Do any of the children you are registering have any special needs? *

Yes No

If "Yes", please explain here *

Bus Information

Parental Consent Form

The undersigned does hereby give permission for the children listed on this electronic form to attend, ride the bus and participate in Family Night activities sponsored by the Osceola Grace Church for 2022.
Authorization
I understand that in the event medical intervention is needed every attempt will be made to contact the persons listed on this form. In the event I cannot be reached in an emergency, I hereby give permission to the physician or dentist selected by the activity leader to hospitalize, to secure medical treatment and/or to order an injection, anesthesia, or surgery for my child as deemed necessary.
I understand that my insurance coverage for my child will be used as primary coverage in the event medical intervention is needed. Coverage by Osceola Grace Church through its accident policy will be used as a backup for what my family’s insurance does not cover.
I understand all reasonable safety precautions will be taken at all times by the Grace Kids children’s staff. I understand the possibility of unforeseen hazards and know the inherent possibility of risk. I agree not to hold Osceola Grace Church, its leaders, employees, and volunteer staff liable for damages, losses, diseases, or injuries incurred by the subject of this form.
By submitting this form I agree to the above authorization.

family night Registration Form - (nursery through adults) wednesdays, September 14-november 16, 6:30-8:00pmmasks are optional

Bus Information

Parental Consent Form

family night Registration Form - (nursery through adults) wednesdays, September 14-november 16, 6:30-8:00pm
masks are optional