Please fill out the form below for any children that will be participating in our Clubs, grade 1-6 (Wednesday 3-5pm) or OneStep, grade 7-10 (Fridays 6-7:30). Look forward to seeing your kids this year! Clubs Registration Clubs Registration Child #1 * <strong>Child #1</strong> First First Last Last Grade * Birthdate (MM/DD/YYYY) * Allergies Registering For: * choose programBoys ClubGirls ClubOneStep Child #2 <strong>Child #2</strong> First First Last Last Grade Birthdate (MM/DD/YYYY) Allergies Registering For: choose programBoys ClubGirls Club Child #3 <strong>Child #3</strong> First First Last Last Grade Birthdate (MM/DD/YYYY) Allergies Registering For: choose programBoys ClubGirls Club Child #4 <strong>Child #4</strong> First First Last Last Grade Birthdate (MM/DD/YYYY) Allergies Registering For: choose programBoys ClubGirls Club Child #5 <strong>Child #5</strong> First First Last Last Grade Birthdate (MM/DD/YYYY) Allergies Registering For: choose programBoys ClubGirls Club Parent/Guardian Information Parent/Guardian Name * Parent/Guardian Name First First Last Last Email Address * Phone * Mailing Address * City * Postal Code * Street Address (if different than above) Please indicate up to 3 people, besides yourself, to whom we may release your child: Pickup Person #1 Pickup Person #2 Pickup Person #3 Emergency Contact Name Phone Freedom of Information and Protection of Privacy Act In accordance with the Freedom of Information and Protection of Privacy Act, Grace Baptist Church requires parental consent for the release of your child's photograph, video clips, or comments in activities that he/she may participate in through church programs. For example, a picture might be posted on the Clubs Facebook Page. Place indicate your consent below: * Yes No Assumption of Risk I realize that all activities have inherent risks. Knowing this I agree to allow my child to participate in GBC regular programs and I accept all risks for any injury which may occur during the participation of my child. Please indicate your consent by checking the box below: * I understand and consent I would like to know more about service and events at Grace Baptist Church: Yes No If you are human, leave this field blank. Submit