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Kid's Club Registration |
Lowell First United Methodist Church Kids' Club Registration and Permission Form Child's Name _____________________________________________ Grade_________ Address ________________________________________ Teacher________________ City, St Zip__________________________________________ Age________________ School_________________________________________ Birth Date_______________ Parent(s) or Guardian(s)__________________________________________________ Email_______________________________________ Phone numbers: --------- aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaHome___________________ ---------aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa Work ___________________ An alternate emergency contact:________________________Cell ____________________ aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa aaCircle the best number to reach Alternate's Phone:___________________________________aaaaaaaayou between 4-5:30. Allergies: --------Food_________________________________ Medicines:_____________________ --------Enviromental __________________________ Other:_______________________ -------- Medications: aaaaaaaaaaaaaaaaaaaaaaPhysical Conditions or Limitations: _____________________________________ ________________________________ _____________________________________ ________________________________ Release Information: List all additional persons to whom your child may be released: ______________________________ _________________________________________________________________________________ My child, named above, has my permission to participate in various special events related to Kids' Club, including field trips and functions away from the Lowell First United Methodist Church. I understand I will be notified, in advance, of thoes field trips and functions. I also give my permission to have my child, named above, transported from school to the Lowell First United Methodist Church by individuals volunteering to do so. I agree to arange pick up of my child from the church at 5:30pm. Signature _________________________________________ Date_________________ Return or mail to: Lowell 1st UMC, 621 E. Main St., Lowell, MI 49331 prior to your child attending Kids' Club |
Alive In Christ |
Lowell First United Methodist Church |