2019-2020 UMC 7th -12th Youth Registration
Registration for grades 7th & 8th and 9th-12th
Sign in to Google to save your progress. Learn more
Email *
Parent/Guardian *
Parent/Guardian
Address *
City, State & Zip code *
Email Address(s)
Number most easily reached at: *
#1 Cell Number: *
#2 Cell Number:
Work Number(s):
Emergency Contact #1 Name, Number & Relationship *
Emergency Contact #2 Name, Number & Relationship *
#1 Child's Name:
#1 Child's Age
#1 Child's Date of Birth:
MM
/
DD
/
YYYY
#1 Child's Grade:
#1 Child's Allergies
#2 Child's Name:
#2 Child's Birthdate:
MM
/
DD
/
YYYY
#2 Child's Age
#2 Child's Grade:
#2 Child's Allergies
#3 Child's Name:
#3 Child's Birthdate:
MM
/
DD
/
YYYY
#3 Child's Age:
#3 Child's Grade:
#3 Child's Allergies
How will your youth get home on Wednesday evenings?
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. *
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.
I further give permission for my child to participate in all activities sponsored by the First United Methodist Church. If yes: type your initials.
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.
Photography Permission Signature & Date: *
Can you help?
Clear selection
Signature: *
Date: *
MM
/
DD
/
YYYY
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Coon Rapids First United Methodist Church. Report Abuse