/files/Trinity Images/Children/feet.JPG/files/Trinity Images/Children/Jforce color.gif

2009-2010 REGISTRATION Form

 

CHILD'S INFORMATION

  Child's Name:   
  Home Address:   
  City:   
  Zip:   
  Home Phone:   
  Birth Date:       

   Grade:   Under 2    2 to 3 Years Old    Pre-K    
               K    1st    2nd    3rd    4th     5th
  Will your child be attending Sunday Morning   or  Wednesdat night Kids' Camp

 

PARENT/LEGAL GUARDIAN INFORMATION

  Father/Guardian Name:   
  Relationship to Child:   Father   Guardian
  Other: 

  Daytime Phone:   
  Cell Phone Number:   
  Email Address:   
  Please provide the following if different from child's:
  Address:   
  City & Zip:   
  Phone:   

  Mother/Guardian Name:   
  Relationship to Child:   Mother   Guardian
  Other: 

  Daytime Phone:   
  Cell Phone Number:   
  Email Address:   
  Please provide the following if different from child's:
  Address:   
  City & Zip:   
  Phone:   

MEDICAL INFORMATION & RELEASE

 Is your child allergic to:

  Bee stings... Will an Epi Pen be made available?  Yes   No

  Over-the-counter medications  Topical ointments   Other drugs
       If so, please list: 

  Food items
       If so, please list: 

  Does your child have any life-threatening allergies or conditions?
      If so, please list:  

Does your child have any physical, emotional, mental, or behavioral concerns or limitations that our staff should be aware of?   If so, please explain:

       

 I further grant permission for my child to receive basic first aid by Trinity UMC.  I understand an incident report will be filled out and I have the right to receive a copy of that report.  In case of medical emergency, I understand that hospital policy requires parental permission before treatment. I hereby grant my permission to Trinity UMC or its designee to secure proper medical treatment, including transport to the nearest hospital for emergency care.  I will be notified immediately and will be advised prior to any further treatment by the hospital doctor.

PICK-UP/RELEASE INFORMATION

Other than yourself, please list all persons to whom we may release your child.

  NAME   PHONE
   
   
   
   

 PARENTAL CONSENT STATEMENT

By completing this online registration form, I hereby consent to let my child participate in Trinity UMC’s activities and grant my permission for photographs or likenesses of my child to appear in Trinity UMC promotional material. It is understood that every precaution will be taken for the safety and well-being of my child, but in the event of accident or sickness, Trinity UMC, its staff, and its volunteers are hereby released from any liability.

 ACKNOWLEDGEMENTS

By completing this online registration form, I hereby acknowledge that I have reviewed all pre-printed personal information, noting any corrections where necessary, and acknowledge that all the information provided is correct. I have read, understood, and agree to all statements contained in this registration form. I understand that I will be contacted if there are any behavior issues which need to be addressed.