Bloomer UMC Children and Youth Programs Registration
This is to register your child, under the age of 18 for the Bloomer United Methodist Church's children and youth programming. Please complete all questions to the best of your ability. One child per form please.
Child's first name *
Your answer
Child's last name *
Your answer
Child's date of birth *
MM
/
DD
/
YYYY
Your first and last name and relationship to the child *
Your answer
Street address *
Your answer
City *
Your answer
State *
Your answer
Zip code *
Your answer
Best phone number to reach you at *
Your answer
Home email address *
Your answer
Emergency contact if not you.
Your answer
Emergency contact phone number (000)000-0000
Your answer
Programming that your child will be attending (select all that apply) *
Required
Child food allergies? If yes please list.
Your answer
Other allergies or special need? If yes please list
Your answer
As part of our children and youth programming we take pictures and post them on social media to promote our church and show the world the ministries that we offer. Your child's photo may be taken and posted on social media unless you indicate below that you do not want their photo posted.
By signing below I have read and answered the above questions and my child has my permission to attend the children and youth programming at Bloomer United Methodist Church. (First and last name) *
Your answer
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