2019/20 Youth & Sunday School Registration
Sparta United Methodist Church - 71 S Sparta Ave. Sparta, NJ 07871 - (973) 729-7773
Child's Name: *
Your answer
Age: *
Your answer
Birth Date: *
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Grade in School (as of September 2019): *
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Address: *
Your answer
Parent/Guardian 1 Name: *
Your answer
Parent/Guardian 1 Phone: *
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Parent/Guardian 1 Email: *
Your answer
Parent/Guardian 2 Name:
Your answer
Parent/Guardian 2 Phone:
Your answer
Parent/Guardian 2 Email:
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Emergency Contact Name (if above cannot be reached): *
Your answer
Emergency Contact Phone: *
Your answer
Emergency Contact Relationship to Child: *
Your answer
Please list any known medical information: *
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Insurance Company *
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Insurance Policy #: *
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Primary Care Physician: *
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Primary Care Physician Phone: *
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Liability Release: By selecting "I agree" below, I hereby give permission for our (my) child named under "Child's name" section of this document above, to attend and participate in activities sponsored by Sparta United Methodist Church for the 2019 & 2020 calendar years and to ride in any vehicle designated by assigned Safe Sanctuary-approved adults. Further, I am also aware that Sparta United Methodist Church employs a Safe Sanctuaries policy in its supervision of children and youth and I may view the policy, if requested, via the church office. In the event of any unforeseen accident, injury, or disability to myself, my child's person, or our property, I will hold harmless and free of liability: Sparta United Methodist Church and Sparta United Methodist Church Youth and Sunday School Leaders, both individually and as a group. *
Required
Photo Release: I understand that photos may be taken during Sparta United Methodist Church Youth and Sunday School events and activities and may include event participants. By selecting "I agree" below, I indicate my permission that photographs, films, or recordings taken as part of these events may be used in print or electronic media created by Sparta United Methodist Church and/or the Greater New Jersey Conference of the United Methodist Church. *
Required
Medical Release: By selecting "I agree" below, I authorize an adult leader in whose care my child has been entrusted, to provide first aid/emergency care to our (my) child named under "Child's name" section of this document above in accord with their judgment, treatment which may include administration of over-the-counter (non-prescription) and/or prescribed medications (for my child) to my child. If it is deemed necessary, I give consent to any x-ray examination, anesthetic, medical, surgical, or dental diagnosis or treatment, and hospital care, to be rendered to my child under the general or special supervision of, and on the advice of, any physician or dentist licensed under the provisions of the medical practice act on the medical staff of a licensed hospital, whether such diagnosis or treatment is rendered at said physician's office or at said hospital. *
Required
By selecting "I agree" below, the parents/guardians listed under "Parent/Guardian Name 1" and "Parent/Guardian Name 2" of this document shall be liable and agree(s) to pay all costs and expenses incurred in connection with such medical and dental services rendered to the aforementioned child pursuant to this authorization. If necessary for our (my) child to return home from an event due to medical reasons or otherwise, the parents/guardians listed under "Parent/Guardian Name 1" and "Parent/Guardian Name 2" of this document shall assume all transportation costs. I UNDERSTAND I AM GIVING UP IMPORTANT LEGAL RIGHTS BY SELECTING "I AGREE" BELOW. *
Required
SUMC Covenant: Both parent(s)/guardian(s) and named child listed under "Child's Name" of this document agree to give their best efforts to this ministry, to respect other participants and their property at all times, and treat others as they wish to be treated. *
Required
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