Kids Club Registration

Child Information

Parent Information

Medical Information

Emergency Contacts

Emergency Contact 1

Emergency Contact 2

Dismissal Information

By clicking accept below, I certify the information is true and I agree to the statement below:

Release of Liability
I understand that in the event medical intervention is needed, every attempt will be made to immediately contact the person(s) listed on this form. In the event I (we) cannot be reached, I give my permission for medical treatment to the health care professional selected by the adult leaders at College UMC.

I understand all reasonable safety precautions will be taken at all times by the church and it’s agents during the events and activities. I consent to any organized travel by bus as part of the activities conducted during the event. I agree not to hold the church leaders, employees and volunteer staff liable for damages, losses, diseases, or injuries incurred.

I consent to my child’s picture to be taken and used for promotional or publicity purposes.

I accept all of the above and attest that the information provided here is correct.

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