PLEASE COMPLETE ONE FORM FOR EACH CHILD

Student Name

First Name

Last Name

Address

Last Grade Completed

Pre-K

K

1st Grade

2nd Grade

3rd Grade

4th Grade

5th Grade

Email

Guardian Name

First Name

Last Name

Guardian #

(###)

###

####

Emergency contact if above cannot be reached (Name & Phone #. 2 people if possible)

Allergies/Medical Conditions

Person other than Guardian authorized to pick up children

First Name

Last Name

Person other than Guardian authorized to pick up children

First Name

Last Name

Person other than Guardian authorized to pick up children

First Name

Last Name

Signature Approval

First Name

Last Name

PHOTO RELEASE

I hereby authorize my consent to allow Trinity United Methodist Church of Mullica Hill, NJ to publish photo and/or video of my child/ren for the purpose of sharing our ministry outreach to the community. This includes websites, social media, and print materials.

Yes

No