Registration Form

First & last name

Address

Child / Youth's birthdate

Child / Youth's age and grade

Please list any known allergies, if any

Current regular medications, if any

Other information or special circumstances

The following people have my permission to pick up my child(ren)

Primary caregiver #1 - Name

Primary caregiver #1 - Cell phone number

Primary caregiver #1 - Relationship to child or youth

Primary caregiver #2 - Name

Primary caregiver #2 - Relationship to child / youth

Primary caregiver #2 - Cell phone number

Emergency contact name (if primary caregivers are unavailable)

Emergency_contact_relationship to child / youth

Emergency contact cell phone

Preferred email(s) for communication regardging events and scheduling

Photo / Video Release: According to CFUMC's Digital Communication Policy - no identifying information, including names will be posted alongside a child's image. I authorize CFUMC to use photos, videos & other images of my child for whom I have legal guardianship which may be used for promotional materials or posted on the CFUMC website & social media pages. Such images will not be sold to other parties. Photo / Video Release: According to CFUMC's Digital Communication Policy - no identifying information, including names will be posted alongside a child's image. I authorize CFUMC to use photos, videos & other images of my child for whom I have legal guardianship which may be used for promotional materials or posted on the CFUMC website & social media pages. Such images will not be sold to other parties. Yes No

Communicating by social media, email and texting waiver: I authorize CFUMC staff and/or volunteers to communicate with my child for whom I have legal guardianship by methods of social media, email and/or texting. Communicating by social media, email and texting waiver: I authorize CFUMC staff and/or volunteers to communicate with my child for whom I have legal guardianship by methods of social media, email and/or texting. Yes No

Signature (please type name to indicate an authorizing signature)

Date