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Power Hour Registration 2019
Grace Lutheran Church
300 S Grant St
Fairmont MN 56031
507-238-4418
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* Indicates required question
Child's Name
*
Your answer
Child's Birthday
*
Your answer
Grade in the Fall 2019
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Preschool (3 by September 1, 2019)
Kindergarten
1st
2nd
3rd
4th
5th
6th
Required
Address
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Your answer
City, State Zip Code
*
Your answer
Child's E-mail
Your answer
Child's Phone Number
*
Your answer
Parent/Guardian's 1 Name
*
Your answer
Parent/Guardian's address (if different from child)
Your answer
Parent/Guardian's 1 Phone Number
*
Your answer
Parent/Guardian's 1 E-mail
*
Your answer
Parent/Guardian 2 Name
Your answer
Parent/Guardian's 2 Address (if different from child's)
Your answer
Parent/Guardian's 2 Phone Number
Your answer
Parent/Guardian's 2 E-mail
Your answer
Emergency Contact
*
Your answer
Emergency Contact's Phone Number
*
Your answer
Where will you serve at Power Hour this year? Please choose one.
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Preschool Team Teacher
Kindergarten Team Teacher
1st Grade Team Teacher
2nd Grade Team Teacher
3rd Grade Team Teacher
4th Grade Team Teacher
5th Grade Team Teacher
6th Grade Team Teacher
Storyteller
Craft/Game Leader
Music Leader
Substitute Teacer
Offering/Attendance
Special Event Support
Tender Loving Children Team
Children, Youth & Family Team
Christmas Program Volunteer
Easter Program Volunteer
Family Fun Fair Coordinator
Activity Expo Coordinator
Other:
Please share medical conditions including allergies, vision/hearing concerns, physical limitations, learning disabilities, or other special concerns etc.
*
Your answer
If my child needs medical treatment while participating, it is my wish that treatment be started while efforts are being made to contact me. I consent to medical procedures deemed necessary by the physician while efforts are continued to contact me. I accept responsibility for all cost related to such emergency treatment.
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Yes
No
My child has permission to take part in all congregational activities, including off-site activities.
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Yes
No
I give my permission to use pictures and the name of my child in publications from Grace Lutheran Church, which may include: bulletin boards, Ways of Grace, Grace website or local newspaper.
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Yes
No
By checking this box and typing your name in below, you are stating that you are authorized to make decisions for the child listed above. Your digital signature on this form will be treated as a written one. Thank You. *
*
I am an authorized parent/guardian for the child listed above.
Type in your Full Name and Date. Thank You!
*
Your answer
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