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Kid's Club Registration |
KIDS' CLUB Child Registration and Permission Form Name __________________________________________________________________ Address ________________________________________________________________ City ____________________________________________________________________ Grade _________________ Child's Age ______ Date of Birth ___________________ E-Mail Address __________________________________________________________ Name of Parent or Guardian ______________________________________________ Telephone Number (s) Where An Adult Can Be Reached: ---------Home_____________________________________________________________ ---------Work _____________________________________________________________ --------Cell ____________________________________Pager______________________ Allergies: --------Food______________________________________________________________ --------Medicine__________________________________________________________ --------Enviromental ______________________________________________________ --------Other _____________________________________________________________ Other Physical Conditions? ________ If yes, please explain __________________ Will someone other than praent or guardian be picking up your child on a weekly basis? --------Name ___________________________________Relationship_______________ --------Telephone Number __________________________________ 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 thos field trips and functions. Also, I give my permission to have my child, named above, transported from school to the Lowell First United Methodist Church by individuals volunteering to do such. Signature _________________________________________ Date_________________ |
Alive In Christ |
Lowell First United Methodist Church |