2019-2020 Registration Form
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Email address
*
Your email
Student's Name
*
Your answer
Nick Name
Your answer
Birth Date
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MM
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DD
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YYYY
Grade
*
Your answer
Gender
*
Your answer
Allergies
Your answer
Physician's Name
Your answer
Physician's Phone Number
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Is there any other information that will help us when working with your student?
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Parents’/Guardians’ Names
*
Your answer
Home Address
*
Your answer
Cell Numbers
Your answer
Other Adults Authorized to Pick Up Student
Your answer
By typing my name in this form below, I give my consent for my student listed above to participate in activities with First United Methodist Church (FUMC). I understand some events include transportation in vehicles driven by pre-screened adults. If my child is injured, I authorize FUMC to provide appropriate medical treatment up to and including a visit to a hospital if needed, and I understand I will be responsible for any treatment costs. I understand that photos of my student may be used to celebrate and promote events within the church, and may be posted online in formats such as Facebook and the FUMC website.
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Please type your full name here
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