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Scripture Highlight

1 John 4:18
“There is no fear in love. But perfect love drives out fear, because fear has to do with punishment. The one who fears is not made perfect in love.”

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GraceNET

About the Youth/Child * Denotes a required field.
Name: *	Home Phone: *
Address:	Birth Date: *
Grade: *	Age: *

	MaleFemale

About the Parents/Guardians * Denotes a required field.
1. Name: *	Email: *
Work Phone: *	Mobile Phone:
2. Name:	Email:
Work Phone:	Mobile Phone:
Where does the family usually attend church?
How did you learn about our LOGOS program?
Emergency Information Who may we contact in case of an emergency?
Name *	Phone *
Name	Phone
Does the child have any health concerns or allergies that you'd like to tell us about?

Pediatrician	Phone
Medical and Photography Releases Authorization for treatment of a minor: My youth/child named above, has my permission to attend trips and special events sponsored by and offered at Grace Presbyterian Church. In the event of illness or accident, if the parent/guardian or emergency contacts cannot be reached, I authorize GPC or its agents to consent to any diagnosis, examination, treatment or hospital care for my child which is deemed advisable by, and is rendered under the supervision of a physician. I release GPC and its agents from responsibility in the case of an accident or illness in connection with any authorized LOGOS activities.
Signature of Parent/Guardian *	Email of Parent/Guardian *
	Signed on This Date *
Do you grant Grace Presbyterian Church permission to use photographs of your youth/child, identified or unidentified, in GPC publicity and publications, including but not limited to Grace Notes, GPC website pages and general publicity brochures, fliers and newspaper articles about GPC programs? * YesNo
Signature of Parent/Guardian	Email of Parent/Guardian
	Signed on This Date
It is strongly encouraged that at least one parent/guardian assist LOGOS by volunteering a block of time for this important ministry for our youth and children. I will assist in the following ways:
Set Tables	Date:
Cook	Date:
Class Asst	Date:
Other	Date:
	If other, please specify below: