Located at Grace Place Ministries, 1600 Jackson Street, Monroe, LA 71202 FOR AGES 5 -12 YRS Parent's Name *Parent's Phone # *Parent's Email Child's Name (1) *Age *Gendar *GirlBoyChild's Name (2) Age Gendar GirlBoyChild's Name (3) Age Gendar GirlBoyChild's Name (4) Age Gendar GirlBoyChild's Name (5) Age Gendar GirlBoyAny allergeries or anything special we need to know about your child? Others allowed to pickup my child: RELEASE OF LIABILITY FORM I hereby agree to be responsible for the conduct and actions of my child/children and to release Grace Place and/or Christ Church from any claims and demands that may occur during participation in the Saturday Child Outreach classes held at Grace Place Ministries, 1600 Jackson Street, Monroe, LA 71202. Furthermore, I agree to release Grace Place and/or Christ Church and it’s staff and/or volunteers and will hold them harmless for any liability which may arise from incidents or accidents involving my child/children and myself while on Grace Place premises, to the extent allowed by law.Parent Digital Signature *I agree to the above liability form.Date Signed * VerificationPlease enter any two digits *Example: 12This box is for spam protection - please leave it blank: 2021-01-11
