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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