Event Permission & Medical Consent for Minors
Thanks for Participating in First United Methodist Church activities. For us to ensure your child is protected and cared for properly we need your permission to particpate in events, permission to take pictures /videos (media is only for church use and names will never be attached to any public document without explicit permission), and permission to care for your child if injured.

To complete this document you will need the following:
Phone numbers of emergency contacts

Your child's Insurance Information

Doctor's Name & Phone number

Participants
Please List names and birthdates of all minors participating in event.
1. Name of Student
Your answer
1. Date of Birth
MM
/
DD
/
YYYY
Phone # (if student has a phone)
Your answer
2nd Participant (if more than 1)
2. Name of Student
Your answer
2. Date of Birth
MM
/
DD
/
YYYY
Phone # (if student has a phone)
Your answer
3rd Participant (if more than 1)
3. Name of Student
Your answer
3. Date of Birth
MM
/
DD
/
YYYY
Phone # (if student has a phone)
Your answer
Parent/Guardian Information
Name of Parent/Guardian
Your answer
Address (Street, City, State, Zip)
Your answer
Primary Phone Number for Parent/Guardian
Your answer
Phone Type
email
Your answer
2nd Parent/Guardian (if different from above)
If Address is the same ignore
Name of Parent/Guardian
Your answer
Address (Street, City, State, Zip)
Your answer
Primary Phone Number for Parent/Guardian
Your answer
Phone Type
email
Your answer
Next
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