Registration Form

Child's name:

Child's age:

Date of birth:

Grade entering in the Fall of 2016:

Address:

City:

Name of parent(s):

Email address:

Home Phone #:

Mother's Cell Phone #:

Father's Cell Phone #:

Emergency contact:

Emergency phone #:

Allergies or other medical conditions:

PARENT’S CONSENT/MEDICAL RELEASE

I (we) understand that, in the event medical treatment is required, every effort will be made to contact me. However, if I cannot be reached, I give my permission to the staff or sponsor bearing this document to act in loco parentis, as provided by Georgia code, to secure the services of a physician to provide the care necessary, including anesthesia for my child’s well-being.

I give permission to Swainsboro First United Methodist Church, its employees and representatives to take photographs, video and/or electronic images in which my child or other family member may appear in a church environment or during a church event and use for any lawful purpose to highlight and promote SFUMC.

Parent/Guardian Name:

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