M&M's Registration 2019-2020
Event Timing: Wednesday evenings starting Sept. 4, 2019
Event Address: 2300 S. Main St., Hope, AR 71801
Contact us at (870)777-8816 or rgagnon50@outlook.com
Email address *
Child's First Name *
If you have more than one child please register each one individually
Your answer
Child's Last Name *
Your answer
Child's Gender
Date of Birth *
MM
/
DD
/
YYYY
Grade they are currently in *
Allergies *
Your answer
T-shirt Size
Home Address *
Street, City, Zip - P.O. Box if applicable
Your answer
Home Phone *
Your answer
Mother/Guardian Name *
Your answer
Driver's License #/ID# *
Your answer
Cell Phone *
Your answer
Email Address *
Your answer
Father/Guardian Name *
Your answer
Driver's License #/ID # *
Your answer
Cell Phone # *
Your answer
Email Address *
Your answer
Emergency Contact *
First and Last Name, contact # if not a parent/guardian, and relationship to child
Your answer
People authorized to pick up your child: *
Please list their first and last names, DL or ID# and relationship to child
Your answer
Other Information we need to know about your child?
Your answer
Do you give permission for your child to be photographed/filmed? *
Photos/Videos may be used for educational or promotional purposes on publicly distributed printed materials, within First United Methodist Church, Hope, or online including our Website, Facebook and other Social Media. Understand that global access to the internet does not allow us to control who may access the photos or videos.
Permission to treat your child: *
As parent or guardian, I hereby give permission for my child to attend M&M's activities at First United Methodist Church. In the event of accident or injury, I will not hold First United Methodist Church or individual ministers or leaders responsible. I do herewith authorize treatment for the above minor in the event of a medical emergency. This authority is granted after a reasonable effort has been made to reach me.
Your signature will be required on this form on the first night of attendance.
Your answer
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