Movie Night - Childcare Registration Form

Child Name (First & Last)

Age

Child Birthday

Allergies/Dietary Concerns

Special Notes/Anything about your child we should know:

Parent Name

Parent Phone

Parent Email

This address will receive a confirmation email

Address

Other guardians allowed to pick up child? List name & cell phone.

By participating in programs, services, and activities of New McKendree United Methodist Church, you agree to the following: On behalf of you and your children you hereby release, covenant not to sue, discharge, and hold harmless New McKendree United Methodist Church, its employees, agents, and representatives, of and from all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating to your participation in our programs, services or activities. You understand and agree that this release includes any claims based on the actions, omissions, or negligence of this organization, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any such program, service or activity.

Agree

My child will stay home if they have experienced any of the following symptoms: fever greater than 99.9 degrees, shortness of breath, cough, chills, muscle pain, new loss of taste or smell, vomiting, diarrhea or sore throat or sore throat in the last 48 hours or if they have any other known contagious illness.

Agree

For promotional and publicity purposes, I will allow my child's picture to be taken and used. Names will not be used to identify person in the pictures.

Agree Disagree

Parent Signature

Description

Saturday, June 14

This form is required for those seeking childcare for our South Campus Movie Night. Childcare is available for kids 3 years (must be potty trained) to 12 years of age.

Movie Night - Childcare Registration Form

Description

Please Fix the Following