Fun Fridays Registration and Medical Release Form
1st Child's Name
Sex Age Grade
Birthdate (mm/dd/yy)
2nd Child's Name
3rd Child's Name
Parent(s) or Guardian(s) - First Name, Middle Initial, and Last Name
Street Address
City Zip
E-Mail to be used for future Fun Fridays notifications
Phone number where you can be reached during the event: This phone number is: Please SelectCell PhoneHome Phone
I will help with Fun Fridays on (select top two preferences)*:Oct 16 Nov 20 Jan 22 Feb 19 Apr 16 May 21
* Parents must volunteer for one Fun Friday event during the year.
MEDICAL RELEASE
In case of an emergency, I understand that every effort will be made to contact me. If I cannot be reached, I give the adult leaders of the children’s activity of Bethany United Methodist Church permission to act on my behalf to consent to any medical treatment deemed necessary. I have read and understand this document. In signing this document I hereby release Bethany United Methodist Church and the adult leaders from any and all liability for personal injury or damage to property and accept financial responsibility should injury or damage occur.
IMPORTANT!By filling in the signature line below, I state that my child’s information is correct. In choosing to be a Parent Fun Helper I state truthfully that I have never been convicted of a criminal sexual offense or a felony of nature, and consent to a criminal background check.
Signature (type in full name)
Signature Date (mm/dd/yy)
Parent(s) Birth Date(s) (mm/dd/yy*) *the year is required for background checks
Enter the numbers as they are shown in the image above