Children and Youth Registration and Release Form
Please fill out this form and click submit.
Date (expires 1 year from date)
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Child Name
*
Address
*
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AA
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AS
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BC
CA
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FL
FM
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Child Cell
Birthday
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Age
*
Grade
School
Allergies/Dietary Concerns
Special Notes
Parent Name
*
Parent Cell
*
Parent Email
*
This address will receive a confirmation email
Parent Name
Parent Cell
Parent Email
Other guardians allowed to pick up child: Name and Cell
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 have been exposed to anyone confirmed to have a Covid-19 infection in last 14 days, if they are waiting for Covid-19 test results, or if they have any other known contagious illness.
*
Please select all that apply.
Agree
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.
*
Please select all that apply.
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 persons in the pictures.
Please select all that apply.
Agree
Signature
*
Submit
Description
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