Dublin FUMC Children's Ministries Registration
2019-2020 School Year
Child's Name *
Age *
Grade *
School *
Birthday *
MM
/
DD
/
YYYY
Mailing Address *
Mother's Name
Mother's Cell Phone Number
Father's Name
Father's Cell Phone Number
Home Phone Number
Email Address
I am most likely to read and remember information I receive via:
Email Preferences
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Emergency Contact Name *
Emergency Contact Number *
Photo Permission: I give permission for my child's photograph or video image to be used for promotional or informational materials, press media, and possible publication on the church website or Facebook pages. *
Does your child have any allergies (i.e. pollen, medications, food, insect bites, etc.)? *
If so, please describe allergy and treatment:
Should this child's activity be restricted for any reason? *
If so, please explain:
I am willing to help with:
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