SMAK Registration Form

 

Monday, July 17 - Friday, July 21

9am - Noon

Performance: Sunday, July 23 - 5:30pm

 

S.M.A.K. is for kids going into 1st through 6th grades starting Fall 2017.

(Please drop off and pick up your child on time each day.)  

Child's Information
Child's Name
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Age:
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Gender:
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Grade:
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Address
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Mom's Name:
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Mom's Phone Number: --
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Dad's Name:
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Dad's Phone Number: --
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Parent's Email
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Photograph Authorization
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I authorize Grace Bible Church to use and reproduce any photos, narratives, interviews, audio and video of my child's participation for any or all purposes. Child's name will not be used in conjunction with any material.
Emergency Contact Information
Emergency Contact:
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Emergency Contact Phone Number: --
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Medical Information
Emergency Medical Care and/or Transport
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I give Grace Bible Church permission to have my child transported to (Hospital/Clinic) for emergency medical care, or to the nearest available source of assistance.
Name of Hospital or Clinic allowed to use:
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Allergies (food,medication or environmental) and precautions, reactions, treatments:
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Medications, food supplements, modified diet currently being administered:
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Chronic physical problems:
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Any Additional health or enrollment information we should know about your child:
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