2023-2024 Children and Youth Information and Release Form

Please fill out this form and click submit. Information will be used to communicate with parents/guardians and also provide volunteers with up-to-date contact information while children and youth are in the care of McCook Memorial Methodist Church.

Child's Name

Birthdate M0/DT/YEAR

Age

Current Grade

Please select one option.

Preschool Kindergarten 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th

Address

Parent/Guardian

Phone

Emergency Contact and Phone Number

This address will receive a confirmation email

We are in need of parents and adults help this year! Please Check all that apply

Please select all that apply.

Help in the kitchen - Please send me the sign up Donate items for supper - Please send me the sign up Volunteer in the classroom - Please send me the sign up Help at dismissal - Please send me the sign up

Allergies/Special Needs

I support the involvement of my child in classes, events and/or activities at McCook Memorial Methodist Church. The above information is most accurate and current. I understand that by selecting this box that if my child is not following rules and warnings, I will sit with them in class or remove them from the classroom/building when notified.

Please select all that apply.

Yes

Photo Release Permission: Occasionally, the church has the opportunity to use photos or video to promote programs, activities, etc. Uses might include a display board, church newsletter, church website, press release, social media, etc. Please select if we have permission to include your child in these photos or videos

Please select all that apply.

Yes No

My child has approval and consent to participate in the activities offered by McCook Memorial Methodist Church. By selecting yes, I understand that the McCook Memorial United Methodist Church and its leaders assume no liability for any accident or injury that may occur during the course of any activities.

Please select all that apply.

Yes No, please contact me for further discussion.

2023-2024 Children and Youth Information and Release Form

Description

Please Fix the Following