Rest Day Child Registration Form

Please register your child for Rest Day by completing this form.  Each child, including siblings, must have a seperate form.  For any fields that do not pertain to that child, simply put "N/A". We will be in touch the week before Rest Day to provide you more information. If you have any questions please contact us at

Thank You!

*Child's First Name:
*Child's Last Name:
*Email to which you want Rest Day information sent:
*Phone Number for Rest Day communication:
*Parent/Guardians Names:
Guardian Email 1:
Guardian Email 2:
Guardian Cell 1:
Guardian Cell 2:
*Emergency Contact Name if parents can't be reached:
*Emergency Contact Phone Number:
School/Day Program:
*Have you attended a Rest Day in the past?:
We provide dinner for your family to take home after Rest Day. We want to make sure we provide enough food and the right type of food for your family members. Please let us know the following information so we can prepare your meal accordingly.:
*Number of people eating the dinner:
Any pertinent dietary restrictions to note?:
The following fields provide us important information about your son or daughter. Knowing this information helps us prepare ahead of time for each child coming. Thank you.:
*What disabilities does your child have?:
What food allergies does your child have?:
What medical allergies does your child have?:
What medications is your child taking?:
What feeding needs should we be aware of?:
*What type of bathroom assistance is needed?:
Explanation of bathroom assistance needed:
What communication needs should we be aware of?:
Does your child have seizures? Please explain.:
Does your child need a 1 on 1 buddy? Why?:
What adaptive equipment does your child use?:
Do you want to make us aware of anything else?:
What does your child enjoy doing? What motivators work well for them? i.e. stickers, cookies, etc:
*Where do you attend Church?:
How did you hear about Rest Day?:
The following questions help protect us, as the respite provider, and you, as the participant.:
*May we take photos with your child in them?:
Should the above registrant, in the opinion of the adult in charge, need medical care, we give permission to seek medical help.:
*Medical Answer:
I will not hold the leaders, staff or volunteers of Grace Fellowship Church responsible for lost, stolen or damaged property brought to Rest Day by myself or my child. The above mentioned respite providers will respect the property of each individual brought to Rest Day.:
*Property Answer:
I will not hold the leaders or staff at Grace Fellowship Church responsible in the event of an accident. As many precautions as possible are taken to protect the safety of every child at Rest Day.:
*Accident Answer:
Buddy Name: