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Participant Registration

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Registro en Español

Grace Global Methodist Church

Location

1206 Smith Street

Waller, TX 77484

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Contact Lisa Solomon:

936-372-3907

pastorlisa.ggmc@outlook.com

First, Tell Us About Yourself:

Parent Information

This Section is Parent/Guardian, Emergency Contact and Child Pickup information.

First Name

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Last Name

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Address 1

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Address 2

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City

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State/Province

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ZIP/Postal Code

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Contact Phone 1

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Contact Phone 2

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Emergency Contact Name

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Emergency Contact Relationship

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Emergency Contact Phone

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Alternate Pickup Name

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Alternate Pickup Phone

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Alternate pickup DL # for security purposes

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Home Church Affiliation

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Click here for your FREE Friends With God Kids Activity Pack

By checking the box you will be emailed your Free Friends With God Kids Activity Pack.

You are also agreeing to receive emails about family resources from Lifetree. You can unsubscribe at any time. We value your privacy. Your information will not be shared with a third party. Lifetree is a division of Group Publishing, the creators of Group VBS and other faith-building resources. Click to learn more about Lifetree.

Tell Us About Your Participant

This section is all about the child attending. Each child must be registered separately. Accepting children leaving Kinder through leaving 5th grade. 6th grade and up are welcome to join us as Junior and Senior Volunteers!

First Name

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Last Name

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Grade Leaving

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Gender

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Date Of Birth

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Shirt Size

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General Health Concerns/Past Medical History/Allergies (N/A if none)

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Any Medications? If you child has a food or insect allergy and has an Epi-Pen, we request we have one during camp in case of emergencies. We will need a separate form if meds are needed during VBS.

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Family Physician Name and Number

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Date of Last Tetanus Shot

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Primary Medical Insurance (Need Ins Phone #, Policy #, Group #, Responsible Party DOB).

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As parent(s), legal guardian(s), or custodian(s) of this child, I/we permit him/her to participate in all officially supervised Grace Global Methodist Church Family Programs and Activities for which he/she is registered. I knowingly release, absolve, indemnify, and hold harmless Grace Global Methodist Church its Members, Trustees, Boards, Leadership, and Staff, as well as counselors, organizers, workers and all others acting on behalf of Grace Global Methodist Church or its programs and activities, from all claims that might result from any accident, personal injury, illness and/or death to the child named arising out of participation in such programs and activities. In the event that my child requires medical or dental attention while attending a Grace Global Methodist Church event, I understand that an adult sponsor of the event will make every reasonable attempt to contact me. In the event that I cannot be contacted, I consent to any medical attention deemed appropriate. In the event that treatment is called for, which the medical provider refuses to administer without consent, I hereby authorize the Grace Global Methodist Church Ministry Leader, Event Coordinators, or any other adult counselor to give such consent for me if I cannot be contacted immediately or, because of an emergency, there is no time or opportunity to make contact. In the event that it is necessary for that person to give consent, I agree to hold such person free and harmless of any liability for damages arising from giving such consent. I declare that my child is covered by medical insurance and/or that I am responsible for any and all expenses incurred to treat my child whether covered under insurance or not. I have read and understand this Medical Release & Consent Form and represent that all of the information contained herein is true and correct. I accept and assume all the risks of injury associated with the activities of Grace Global Methodist Church Family Ministry.

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Photograph Release: Regarding photographs of my child taken during VBS, I DO give Grace Global Methodist Church permission to the following for non-profit use and without charge: use at the discretion of Grace Global Methodist Church display at a service or event or be used in a multimedia presentation, reprint distribution for any Grace Global Methodist Church non-profit publication, and/or social media promotion including Grace Global Methodist Church website.

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Comments

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Do you have friends you would like to be placed with? We will do our best to group selected friends together in the same crew, but we cannot promise all requests will be possible.

Friend 1 First Name

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Friend 1 Last Name

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Friend 2 First Name

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Friend 2 Last Name

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Friend 3 First Name

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Friend 3 Last Name

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