St. Luke's All God's Children Registration Form
*Update 9/05/2018: Our 4th and 5th grade class is full at this time. We are only accepting PreK4- 3rd grade students until further notice.*
Please complete the form below. Please do not enter multiple students on one form; fill it out for each child. Thanks
Child's Last Name *
Your answer
Child's First Name *
Your answer
Child's Birthday *
MM
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DD
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YYYY
Child's 2018-2019 School Grade *
Which school does your child attend? *
Parent's/Legal Guardian's First & Last Name *
Your answer
2nd Parent's Name (If applicable)
Your answer
Home Address (Please list both if more than one parent/guardian.) *
Your answer
Home Phone Number (Please list both if more than one parent/guardian.) *
Your answer
Cell Phone Number (Please list both if more than one parent/guardian.) *
Your answer
Work Phone Number (Please list both if more than one parent/guardian.) *
Your answer
Parent(s) E-Mail Address (Please list both if more than one parent/guardian.) *
Your answer
Emergency Contact Person's Name & Phone Number *
Your answer
Health Information: Does your child have any allergies or medical conditions that The Children Ministry Team should be aware of? (Yes or No) If so, please specify. *
Your answer
Please list any medications that your child currently takes. (Please skip this question if not applicable.)
Your answer
EMERGENCY MEDICAL CONSENT: Please read both statements below. 1) In the event my child suffers any illness or accident requiring emergency hospitalization, medication, or surgery while participating in any activity/event, on the recommendation of the doctor, after consultation with the adults in charge of the activity/event, I hereby give my permission for any medical treatment which may be deemed necessary and reasonable under the circumstances, understanding that the activity coordinator or other responsible person will contact me at the earliest possible moment and 2) I fully understand and comprehend that reasonable care will be exercised by the adult staff for all activities/events to protect the safety of all those involved. PLEASE NOTE: BY ENTERING YOUR NAME BELOW, YOU ARE INDICATING THAT YOU ARE IN AGREEMENT WITH THE TWO STATEMENTS ABOVE. *
Your answer
LIABILITY WAVER: Safety is of paramount importance in every activity. For the protection of all involved, this disclaimer is necessary. I do not hold the Church Council, Trustees, members or staff of St. Luke’s United Methodist Church or the church itself, or any volunteer liable for any injury, property damage, bodily harm, accidents or death of myself/my child during events sponsored by St. Luke’s United Methodist Church. PLEASE NOTE: BY ENTERING YOUR NAME BELOW, YOU ARE INDICATING THAT YOU ARE IN AGREEMENT WITH THE STATEMENT ABOVE. *
Your answer
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