My Grace

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Childcare Registration Form (COVID Protocol)

We provide limited childcare to support classes and groups which meet on campus. Cost is $6 for the first child and $2 for each additional child. Plan to pay with cash when you arrive. 
Please complete one form for each child. We are now able to accept Infants through 5th grade.

*Address Line 1
Address Line 2
*City
*State/Province/Region
*Zip/Postal Code
I acknowledge that federal and state government officials have declared that there currently exists a public health crisis in our country related to the Coronavirus Disease 2019 ("COVID 19").
*Please enter your initials to acknowledge this statement.
I confirm that I will not permit my child to participate in Grace Childcare if, at any time during the program or activity, my child is showing any symptoms of COVID-19 (including but not limited to fever, dry cough, fatigue, shortness of breath, chills, muscle pains). Additionally, I confirm that I will not permit my child to participate in Grace Childcare if, at any time during the program or activity, my child has been in contact with any individual diagnosed with COVID-19 or any individual currently waiting for test results confirming the possibility of a COVID-19 diagnosis. I agree that in such situations my child will be unable to participate in Grace Childcare until: (i) 14 calendar days after the symptoms first appeared and my child is no longer showing any symptoms; or (ii) a healthcare provider has confirmed in writing that my child has tested negative for COVID-19 or that my child's symptoms were not due to COVID-19.
*Please enter your initials to acknowledge this statement.
I understand that Grace Childcare cannot prevent the possible transmission or contraction of COVID-19 for my child.
*Please enter your initials to acknowledge this statement.
The undersigned agrees to release, discharge, hold harmless and indemnify Grace Church Saint Louis, its agents, employees, volunteers, and others acting on the church's behalf (the "Releasees"), of and from any and all claims, demands, causes of action and/or legal liabilities for injuries to or death of my child occurring during, resulting from, or participation in the above mentioned program or activity and related in any way to COVID-19, even if the cause, damages or injuries  are alleged to be the fault of or alleged to be caused by the negligence or carelessness of the Releasees.
*Please enter your name as signature to acknowledge this statement.
*Please list your child's name (first and last).:
*What is the age of your child today?
*What is your child's birthdate?
*What grade is your child this school year?
*Does this child have any allergies or special needs?
If Yes, please list:
*What class or event are you attending?
*What day of the week is your class or event?
*What dates will the child be attending Grace Childcare?
*What time does your class start and end?
We ask that you pay with cash upon arrival.
By signing below, I give  permission for my child/ward, named above, to participate in Grace Childcare at Grace Church Saint Louis.
Submit Form