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Grace Community Schools Enrollment Application | ![]() |
| (Fill out this form and click the print button at the bottom to print) | ||
| Child's Name: | |||||
| Birth Date: | Sex: | Social Sec.# | |||
| Mother | Father | ||
| Name: | Name: | ||
| Address: | Address: | ||
| Home Phone: | Home Phone: | ||
| Work Phone: | Work Phone: | ||
| Cell Phone: | Cell Phone: | ||
| Social Security #: | Social Security #: | ||
| 4-Digit PIN | 4-Digit PIN | ||
| Emergency Contacts / Persons Permitted to Pick up Child | |||
| (Other than Parents) | |||
| Name: | Phone #: | ||
| Name: | Phone #: | ||
| Name: | Phone #: | ||
| Name: | Phone #: | ||
| Special Instructions | |||
| Parents Agreement | |||
I hereby give my consent to have my child treated by a physician for medical or surgical care should an emergency arise. I understand that every effort will be made to contact me or a relative before such action is taken. |
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Date
Parent or Guardian Signiture
