2018 - 2019 Dynamite Disciples Registration
Email address *
Dynamite Disciples Logo
*children must be 4 years old by Sept 1st to attend.
Parent/Guardian *
Your answer
Parent/Guardian
Your answer
Address *
Your answer
City, State & Zip code *
Your answer
Email Address(s)
Your answer
Home Phone Number: *
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, Date of Birth, Age, Grade
Your answer
#1 Child's Allergies
Your answer
#2 Child's Name, Date of Birth, Age, Grade
Your answer
#2 Child's Allergies
Your answer
#3 Child's Name, Date of Birth, Age, Grade
Your answer
#3 Child's Allergies
Your answer
#4 Child's Name, Date of Birth, Age, Grade
Your answer
#4 Child's Allergies
Your answer
#5 Child's Name, Date of Birth, Age, Grade
Your answer
#5 Child's Allergies
Your answer
List the people who are allowed to pick-up your child(ren) each week: *
Your answer
My child(ren) may walk home after Wednesday night church school class. *
My child(ren) may ride their bike home after Wednesday night church school class. *
Permission to Photograph: I am the parent or legal guardian of the above listed child(ren). I understand Coon Rapids Methodist Church may photograph the events or activities in which my child(ren) will participate as part of UMC’s Dynamite Disciples Program. I give my permission for the church to use photographs my child(ren) 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 child(ren) at this time nor in the future for the use of my child(ren)'s likeness. No child will be identified specifically by name. Parent/Guardian Signature: *
Photography Permission Signature & Date: *
Your answer
Can you help?
Signature: *
Your answer
Date: *
MM
/
DD
/
YYYY
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service