2019-2020 UMC 7th -12th Youth Registration
Registration for grades 7th & 8th and 9th-12th
Email address *
Parent/Guardian *
Your answer
Parent/Guardian
Your answer
Address *
Your answer
City, State & Zip code *
Your answer
Email Address(s)
Your answer
Number most easily reached at: *
Your answer
#1 Cell Number: *
Your answer
#2 Cell Number:
Your answer
Work Number(s):
Your answer
Emergency Contact #1 Name, Number & Relationship *
Your answer
Emergency Contact #2 Name, Number & Relationship *
Your answer
#1 Child's Name:
Your answer
#1 Child's Age
Your answer
#1 Child's Date of Birth:
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#1 Child's Grade:
Your answer
#1 Child's Allergies
Your answer
#2 Child's Name:
Your answer
#2 Child's Birthdate:
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#2 Child's Age
Your answer
#2 Child's Grade:
Your answer
#2 Child's Allergies
Your answer
#3 Child's Name:
Your answer
#3 Child's Birthdate:
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#3 Child's Age:
Your answer
#3 Child's Grade:
Your answer
#3 Child's Allergies
Your answer
How will your youth get home on Wednesday evenings?
Your answer
Permission to Photograph: I the parent or legal guardian of the above-listed youth. I understand Coon Rapids Methodist Church may photograph the events or activities in which my youth will participate as part of UMC’s Dynamite Disciples Program. I give my permission for the church to use photographs of my youth during these activities for the purpose of promoting the church and its program. I understand no compensation of any kind will be paid to me or my youth at this time nor in the future for the use of my youth's likeness. No youth will be identified specifically by name. If yes: type your initials. *
Your answer
In the event of a medical emergency, I hereby authorize the Children & Youth Ministry leaders, volunteers, First United Methodist Church, hospitals, licensed medical or dental providers, and their agents and employees to have access to the information contained in this form and to provide all medical or dental care, treatment, and necessary transportation advisable for the health and safety of my child. If yes: type your initials.
Your answer
I further give permission for my child to participate in all activities sponsored by the First United Methodist Church. If yes: type your initials.
Your answer
I further give permission to receive text messages to communicate cancelations, reminders, etc. about my youth’s participation in all activities sponsored by the First United Methodist Church. If yes: type your initials.
Your answer
Photography Permission Signature & Date: *
Your answer
Can you help?
Signature: *
Your answer
Date: *
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