Program Year Registration 2024-25 (in English)

Welcome! Children and youth are at the center of our ministry here at Grace Church, and we are SO excited to begin another program year full of worship, learning, service, and fun!

If you have questions, reach out to Mother Emma (emma.brice@gracealex.org) for assistance.

Tell us a bit about your child...

Legal Name of Child/Youth

Nickname/Preferred Name

Gender of Child/Youth

(Optional) Preferred Pronouns (he/she/they/etc)

At Grace, we seek to respect the dignity of every child and youth and to build an inclusive community. One way we do this is by calling each person by their preferred name or nickname and their preferred pronouns. For more information about pronouns, check out this article.

Birthday of Child/Youth (month/day/year)

What school does your child/youth attend?

Primary Address of Child/Youth

(Optional) Email Address of Youth

(Optional) Cell Phone of Youth

Does your child/youth have any food allergies/dietary restrictions or preferences?

Does your child have any health issues, allergies, or additional needs we should be aware of?

Please tell us anything you believe would be helpful for us to know about your child.

Help us plan for the year ahead...

Has your child already been baptized?

Yes No I don't know

Has your youth already been confirmed in the Episcopal Church?

Yes No I don't know

Are there specific times in the average week when your child/youth is more often available?

Are there regular times that your child/youth is unavailable?

Do you have any suggestions or feedback as we plan the program year ahead?

Tell us a bit about the grown-ups...

Parent/Guardian #1 Name

Parent/Guardian #1 Email Address

This address will receive a confirmation email

Parent/Guardian #1 Cell Phone Number

Parent/Guardian #1 Home Phone Number

Parent/Guardian #1 Address (if different than the child)

Parent/Guardian #2 Name

Parent #2 Email Address

Parent #2 Cell Phone Number

Parent/Guardian #2 Address (if different than the child)

Emergency Contact if parent is not available

Emergency Contact Relationship

Emergency Contact Phone Number

Permissions

Participation: I/We hereby grant permission for my/our child to engage in the various activities sponsored by Grace Episcopal Church for children/youth during the 2024-25 academic year and summer 2025.

Yes

Medical Attention: My/Our permission is granted for adult staff and volunteers working with Grace Church to obtain necessary medical attention in case of injury or sickness during any events for my/our child named above. My/Our permission is granted to make any medical decisions in the event of an accident or injury when parental consent is unavailable or when circumstances require an immediate decision.

Yes

Transportation: I give permission for my child to be transported to youth activities in conjunction with any above mentioned events, away from our meeting site, in any vehicle designated by the adult in whose care the minor has been entrusted while attending and participating in this event. Drivers will be approved by Grace Church and adhere to Diocesan guidelines.

Yes No

Waiver: I/We as indicated below do hereby release, remise and discharge adult sponsors, Grace Episcopal Church, and the Diocese of Virginia from any liability, claims, demands, actions or cause of action, past, present & future arising out of any injury while participating in Church-related events.

Yes

Photography Policy

Grace Episcopal Church Photo and Video Policy: Photographs and videos taken during church-sponsored events may be published in Grace Notes and/or other Grace Church media, including but not limited to the church’s website, photo collage board, Facebook page, and Instagram. Photos and videos posted to the church website, on the church's Facebook page, or the church's Instagram page can be removed if requested. Names of minors appearing in photos and videos are not published. Parents who wish to request that images of their minor children be excluded from appearances in official Grace Church media are invited to do so by contacting the parish office.

Health Insurance Information (Optional)

Health Insurance Company

Policy #

Policy Holder

Relation to Child/Youth

Program Year Registration 2024-25 (in English)

Description

Please Fix the Following