Sunday School Registration/Photo Release Form

Online registration for Pre-K through grade 5.

Please submit one form per child.

Sunday School Registration/Photo release
Name of Child (First, Middle, Last):

Please list all medical conditions limiting child’s activity (I.e. food allergies, medication allergies, and physical limitations).

Birth date:

Age:

Grade in 2012-2013

Is your child enrolled in the Children's Growing Center?
Yes

No

Is your child baptized?
Yes

No

Child's address (street, city, state and zip):

Mother's Information

Mother's name:

Mother's address:
Same as child's

Mother's address (street, city, state and zip):

Mother's E-mail address:

Mother's home phone:
(Please include area code in phone numbers.)

Mother's work phone:

Mother's mobile phone:

Father's information:

Father's name:

Father's address:
Same as child's

Father's address (street, city, state and zip):

Father's E-mail address:

Father's home phone:
Please include area code.

Father's work phone:

Father's mobile phone:

Emergency information

Emergency contact (name, relation and phone number):

Health care provider and phone number:

Pickup Arrangements

Please list all persons and their relationship who are authorized to pick up your child:
Please be aware that the adults listed above are the only persons to whom we will release your child.

Photo Release
I am aware that photographs or video may be taken of First United Methodist Church (FUMC) Children's Ministry participants during events, activities, and classes by FUMC staff members, professional photographers, news media or volunteers. I also understand that my child is not required to hav his/her picture taken.

I waive the right to see or approve any publications that contain photographs of my child.

I release FUMC and its representatives from responsibility for any harm or invasion of privacy that may occur or be produced by taking photographs or video of my child.

I certify that I have read the above authorization, release, and agreement, and fully understand what this document says.

I give FUMC and its representatives permission to use photographs or video that include my child in any and all media products for promotion, art, advertising, editorial or other purpose. This may include but is not limited to newsletters both print and email, posters, brochures, ads, post cards and web pages.

Yes, I agree to above stated photo release.

No, I do not agree to above stated photo release.

*
Parent/Legal guardian of above enrolled child

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Sunday School Registration/Photo Release Form

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