First United Methodist Church

Youth & Child Permission Form

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First Name Last Name


First Name Last Name
Phone Number
Phone Number
It is assumed that all due care and precaution will be taken by the First United Methodist Church staff and members in attendance at the above stated event. Beyond that, the First United Methodist Church will assume NO responsibility.
Select one
No
Yes (please list below)
Select one
No
Yes (please list below)
Select one
Yes
No
Select one
Yes
No (If no, a registration form can be found on the website)
Select one
Yes
No

First Name Last Name
I understand that my behavior is either a positive or negative reflection of Chelsea First United Methodist Church, agree to participate to the fullest of my ability, and to follow the rules of the event.

First Name Last Name
* required