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Girls in Action Registration
Please fill out emergency, medical, and other information about your daughter who will be in GA's.
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* Indicates required question
Email
*
Your email
Child's name
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Grade in school
*
1st
2nd
3rd
4th
5th
6th
Allergies or other necessary medical information
*
Your answer
T-shirt size
*
Child Small
Child Medium
Child Large
Child X-Larg
Adult Small
Adult Medium
Adult Large
Adult X-Large
List any medications and dosage that leaders have permission to give your child if needed:
*
Your answer
Parent/Guardian Name
*
Your answer
Address
Your answer
Phone #
Your answer
What location in the church will the parent/guardian be on Wed. nights?
Your answer
Emergency Contact name
Your answer
Emergency Contact phone #
Your answer
Please list names of people other than parents allowed to pick your child up:
Your answer
Insurance Company
Your answer
Insurance Policy #
Your answer
Family Physician
Your answer
May we have permission to photograph your child and use photos for our church website, social media, or any other promotion?
*
Yes
No
Are there any other concerns you'd like to share with us about your child?
Your answer
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