2018-19 UMC Wednesday 7th-12th Youth Church Group - Registration
Registration for grades 7th & 8th and 9th-12th
Email address *
Parent/Guardian *
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Parent/Guardian
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Address *
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City, State & Zip code *
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Email Address(s)
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Home Phone Number: *
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#1 Cell Number: *
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#2 Cell Number:
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Work Number(s):
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Emergency Contact #1 Name, Number & Relationship *
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Emergency Contact #2 Name, Number & Relationship *
Your answer
#1 Child's Name, Date of Birth, Age, Grade
Your answer
#1 Child's Allergies
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#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
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#4 Child's Name, Date of Birth, Age, Grade
Your answer
#4 Child's Allergies
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#5 Child's Name, Date of Birth, Age, Grade
Your answer
#5 Child's Allergies
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List the people who are allowed to pick-up your child(ren) each week: *
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Permission to PhotographI 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: *
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Can you help?
Signature: *
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Date: *
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