A Caring Community With a Global Vision to develop every person into a fully devoted follower of Christ
 

Children's Music and Children's Choirs
Registration Form

2008-09

Please carefully read the following document prior to completing the registration form:

 
REGISTRATION FORM:

This form needs to be completed by the parent/guardian of a child.

Please complete one form per registrant:

TIME: OPPORTUNITY:
5:30 p.m. MOVEMENT/DANCE (4th-6th Grade)
5:30 p.m. ORFF (4th-6th Grade)
6:00 p.m. CHOIR
Parent/Guardian’s Name(s)
Child's Name:
Child's Grade: Check one of the following boxes:
  Age 3 by Sept. 1
  Age 4 by Sept. 1 and PreSchool
  Kindergarten
  1st Grade
  2nd Grade
  3rd Grade
  4th Grade
  5th Grade
  6th Grade
Birth Date:
Current Age:
Address:
City:
Zip:
Allergies: Please list any special needs / allergies
Special Needs? Anything we can do to help your child
Home Phone:
Cell Phone:
Email address: (required field for online registration)
Would you be willing
to help if needed:		 Yes No
Where, or how, can we
reach you from 5:15-6:45?
Where my child will
go after class:



Please list who has permission
to pick up your child:

 

The following sections must also be completed for each child registrant.

Parental Release for Use of Student Images in all Formats:

*Unless otherwise noted below, I(we) authorize the First United Methodist Church, Niceville, Florida, and those acting with its permission and under its authority, to use and publish recognizable images of my child in any medium deemed appropriate, but not limited to:

a. Web pages

b. Newspapers

c. TV (Local Broadcasts to homes)

d. Multi-media Presentations

e. Pictures for professional journals/brochures.


 

Parent / Guardian Signature: *Checking this check-box at left constitutes your electronic signature of photo authorization or non-authorization as indicated above and outlined in detail on the release form. We warrant that we are the guardian and/or parents of the above named child and have full right to contract on behalf of said child.

Name: Date:

 

Liability Release Form

I/We, signed below, agree to exempt and relieve First United Methodist Church of Niceville and its officers, agents, servants or employees from liability for both personal injury and/or property damage caused by/to:
Name of Participant: .

Emergency Information:

Hospital Insurance Company:

Policy and Group Number:

Physician's Name and Phone Number:

Parent / Legal Guardian Signature: *Checking the check-box at left constitutes your electronic signature for the liability-release form as stated above. We warrant that we are the guardian and/or parents of the above named child and have full right to contract on behalf of said child.

Name of Parent/Legal Guardian: Date:

 

NOTE: After completing the form, use your mouse to click on "Submit", rather than using the Enter key.

*Please enter comments or questions here:

After clicking the "Submit Form" button below, please wait until the next page appears. If you do not receive a confirmation email, please call 678-4411, ext. 126.