Club KidsRock Registration 2023-2024
Club KidsRock is for kids from Kindergarten to 5th grade to come together for a fun night of games, music, crafts, and discipleship.  This will take place every first Friday of the month at Granite City Church located at 315 Whitwell Street in Quincy from 7:00 PM -8:30PM starting on Friday, October 6th.  Pre-register your child below. 
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Email *
Child's First and Last Name *
Current Grade  *
Address *
E-mail  *
Parent/Guardian Names  *
Parent/Guardian Phone Numbers  *
Additional Emergency Contact (Name and Phone Number)
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Pediatrician Name and Phone Number 
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Does your child have any medical conditions we should be aware of? If yes, please describe below. 
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Does your child have any allergies (food, medications, etc)
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Does your child have any dietary restrictions?
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Does your child have any physical or emotional needs that it would be helpful for us to be aware of? Our goal is to make each and every child feel safe and welcome. If yes, please explain below.
MEDICAL RELEASE:
If I am unable to be reached, I authorize the adult volunteers of Granite City Church to consent to any medical care deemed advisable by an accredited physician or surgeon in an emergency clinic or hospital. Please answer yes or no and type your name as a legal parent/guardian. 
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Please list the names of people who are authorized to pick up your child.  Whoever picks up your child may be required to show a picture ID. 
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I give Granite City Church permission to use photos of my child on the church's social media accounts (facebook, instagram, youtube) with the understanding that his/her name will not be used. 
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Any other information about your child we should be aware of? 
A copy of your responses will be emailed to the address you provided.
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