GLOW 2025/2026 registration

Child's Name *

First Name

Last Name

Parent/Guardian's Name *

First Name

Last Name

Parent/Guardian's Phone *

(###)

###

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Alternate Emergency Contact Name *

First Name

Last Name

Emergency Contact Phone *

(###)

###

####

I understand that Immanuel makes every effort to maintain a healthy and safe environment. However, I know there are still risks associated with attending group activities, and sometimes unforeseen circumstances. I will not hold Immanuel, its staff or volunteers, responsible in the event my Child experiences sickness or injury as a result of attending kids events at Immanuel. *

I agree to the above statement

I will not send my Child to attend events if they are experiencing any signs of illness. *

I agree to the above statement

Email Updates *

Would you like to receive email updates about Immanuel Church and Kids events?

Yes

No

Consent to Publish

We occasionally take videos and photographs of our VBS program. Do you consent to having your Child's photo used on our social media platforms and/or website?

Yes

No - If No, I agree it is my responsibility to email alicia@immanueltruro.org to notify staff