Children's Programs Registration

This registration form is the universal form for all children's programs here at Grace and St. Stephen’s. Please complete a separate registration form for each child. If your child will join Sunday School and St. Nicholas choir, you can choose both of those options and complete just one form.

Nursery (3 months-3 yrs)
Sunday School (PreK-5)
St. Nicholas Choir (3rd-8th grade)

** if no special information regarding your child's care while in our care is needed, please type NONE in these fields.

Children's Programs Registration Form

I am registering my child for

Nursery (3 months-3 yrs)

Sunday School (PreK-5th grade)

St. Nicholas Choir (3rd-8th grade)

Child's First Name

Child's Middle Name

Child's Last Name

Date of Birth (including year)

Grade (if applicable)

Parent/Guardian First & Last Name (1)

Relationship

Address (ST/PO #, City, State & ZIP

Email address

Phone number

Parent/Guardian First & Last Name (2)

Relationship

Email address

Phone number

1st Emergency Contact Name & Phone #

2nd Emergency Contact Name & Phone #

**List medical conditions we need to know about

**List any medications to be administered while in our care

**List any dietary allergies/needs

**List any other special needs your child has

**List any other accommodations needed for your child

Medical Release: In case of emergency, I understand that a reasonable effort will be made to contact me. If I cannot be reached, I hereby give an agent of Grace and St. Stephen’s permission to act on my behalf to seek emergency medical treatment for my child in the event that such treatment is deemed necessary by the agent. I give permission to any licensed physician selected by this agent to administer such emergency treatment as said physician in his/her judgement deems necessary in the circumstances; and hereby absolve Grace and St. Stephen’s Episcopal Church, its agents and employees from any and all liability resulting from their conformance with these instructions. I agree with the Medical Release.

Yes

Media Release: Photographs and videos may be taken at Grace and St. Stephen’s Episcopal Church to be used for any of these purposes: written promotions; mailings; website, social media and audio/visual presentations. No names will be used. By agreeing to this Media Release, you give permission for your child’s photo/voice to be used in the above ways. I agree with the Media Release.

Yes

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Children's Programs Registration

Children's Programs Registration Form