High School Youth Night Registration • Grace Church Online

Registration

Only one section can be filled out per child.

Child's First Name *

Child's Last Name *

Parent Phone Number *

Parent Email Address *

Health Check

This section must be filled out on this form and will be asked to your child before entry into Grace Church.

Has your child developed any new COVID-19 related symptoms? *

Yes

Has your child come into contact with anyone with COVID-19 and are legally required to self-isolate? *

Yes

Has your child entered the country within the last 14 days or been in contact with someone who has within the last 14 days and are legally required to self-isolate? *

Yes

Release of Liability

As the Parent/Guardian, I authorize that this information is correct and am aware that sending my child to Grace Youth Group raises the likelihood of transmission *

Type name of parent/guardian