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MUMC Children and Youth Programs
Sunday School and Wednesday Red Brick Learning Sign-up
Email address *
Student Full Name *
Your answer
Preferred Name
Your answer
Grade *
Check All Programs desired *
Required
Birthdate *
MM
/
DD
/
YYYY
Gender
Street Address *
Your answer
City *
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Zip Code *
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Food Allergies
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Special Needs
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Primary Guardian/Parent's Full Name *
Your answer
Primary Address (only if different than child's)
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Primary phone *
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Emergency Contact's Name *
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Emergency Phone *
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Emergency Address
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Relationship to child *
Your answer
My child may be published in media form *
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Red Brick Learning (Wednesday) Transportation
Arrival by 3:15 pm. Pick up by 5:15 pm.
How will your child be arriving to the church? *
If other, include the names and phone numbers.
Your answer
Who will be picking your child up from church? *
If other, include the names and phone numbers.
Your answer
I, the undersigned parent or guardian, hereby authorize emergency medical, dental, health or hospital services be rendered to my child upon consent of a Milaca United Methodist Church staff member or designated volunteer. The purpose of this authorization is to permit my child to receive emergency medical attention when needed while involved in the activities connected with Red Brick Learning program when I or my emergency contact is unavailable to give such consent. I also hereby give permission for my child to ride in any vehicle designated by the adult in whose care the minor has been entrusted while attending and participating in any activity sponsored by Milaca United Methodist Church – Red Brick Learning Program. *
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