Children & Youth Ministry Registration Form

CHILD INFORMATION

Name

Date of Birth (mm/dd/yyyy)

Age

Gender

Address

Sunday Morning Best Phone Number

PARENT/GUARDIAN INFORMATION

First Name

Last Name

This address will receive a confirmation email

Home Phone

Mobile Phone (If different from "Sunday Morning Best Phone Number"

Address Same as Child?

Yes No (Enter Below)

Address

Can anyone other than the Parent/Guardian above pick up child?

Yes No

If Yes: Those authorized to pick up my child are (Must list first/last name & relationship to child)

MEDICAL INFORMATION

Does your child have allergies?

Yes No

If Yes, list allergies:

Does your child have any condition that would prevent them from participating in any of the activities of this program?

Yes No

If Yes, list condition and type of activity:

Does your child have any dietary restrictions?

Yes No

If Yes, list restrictions:

Any other information that would help us understand your child's needs?

Emergency Contact (In the event we cannot reach you)

First Name

Last Name

Relationship to Child:

Best Contact Number:

Permission for Treatment
I understand that in case of emergency, I will be notified. However, my permission is granted for all staff and volunteers’ part of/acting on behalf of the Children and Youth Ministry at the United Methodist Church at New Brunswick to obtain or provide necessary medical attention in case of sickness or injury to my child.

I agree and understand that any typed signature is considered the same as providing a manual/handwritten signature and equally binding.

Signature of Parent/Guardian

Date (mm/dd/yyyy)

PHOTO RELEASE

I understand that my child may be photographed at the different events organized or attended by the Children and Youth Ministry of United Methodist Church at New Brunswick. I understand that these photographs may be used during worship service or on the church website, including social media pages (Facebook, Instagram). For protection of privacy of the child, we guarantee that names will not be included. I hereby grant and authorize the Children and Youth Ministry at the United Methodist Church at New Brunswick to make use of photos involving my child. I do not allow the use of the photos taken involving my child.

Each child is required to have an updated photo in our church database to participate in the ministry. You may upload a photo below, email to lucia@umcnb.org or one can be taken before/after worship per request.

Upload a Photo Here:

Upload (8MB)

If you cannot upload a photo, please choose another option

I have read, understand, and agree with above and sign it in consent to the child named above to participate in activities at/organized or attended by the Children and Youth Ministry of United Methodist Church at New Brunswick.

In the event changes need to be made to the information provided, I will do so in writing to the Director of Children and Youth Ministry, Lucia Williams at lucia@umcnb.org.

I agree and understand that any typed signature is considered the same as providing a manual/handwritten signature and equally binding.

Signature

Date (mm/dd/yyyy)

Children & Youth Ministry Registration Form

Description

Please Fix the Following