Abundant Grace Community Church

Participant Info

First Name

Last Name

Phone Number

Age

Gender

Male

Female

Any medical conditions

Yes

No

Please list any and all medical conditions

Any Allergies

Yes

No

Please list any and all Allergies

First Name

Last Name

Phone Number

Does ISM leadership Have permission to apply basic first aid as needed?

No

Yes

Signature

(956)381-0622
info@agcc.tv

2110 S. McColl Road
Edinburg, TX 78539