(Birth through Grade 5)

    * Required

    Today's Date:*(this Information Form remains valid for one year from today’s date)

    Name of Child:*

    Grade:*

    Parent/Guardian's Name(s):*

    Street Address:*

    City:*

    E-Mail:*

    Phone/Cell:

    Birthdate:

    Age:

    Secondary Contact Name/Phone:

    Where will you be during Sunday School (Worship, Small Group, etc.) and what is the best way
    to contact you (call, text, etc.)?

    Who has permission to pick up your child? (please list all names)

    Child's allergies:

    Child's special needs:

    Medical insurance company:*

    Policy #:*

    Choice of hospital:

    (name of student) has my permission to participate in the following activities sponsored by Wooster United Methodist Church:

    Sunday SchoolNurseryChildcare during church functionsOther

     

    This consent form gives permission to seek whatever medical attention is deemed necessary, and releases the church and its staff of any liability against personal losses of named child.

    I/We the undersigned have legal custody of the student named above, a minor, and have given our consent for him/her to attend events being organized by the church. I/We understand that there are inherent risks involved in any ministry or athletic event, and I/we hereby release the church, its pastors, employees, agents, and volunteer workers from any and all liability for any injury, loss, or damage to person or property that may occur during the course of my/our child’s involvement. In the event that he/she is injured and requires the attention of a doctor, I/we consent to any reasonable medical treatment as deemed necessary by a licensed physician. In the event treatment is required from a physician and/or hospital personnel designated by the church, I/we agree to hold such person free and harmless of any claims, demands, or suits for damages arising from the giving of such consent. I/We also acknowledge that we will be ultimately responsible for the cost of any medical care should the cost of that medical care not be reimbursed by the health insurance provider. Further, I/we affirm that the health insurance information provided above is accurate at this date and will, to the best of my/our knowledge, still be in force for the student named above.

    Parent/guardian signature*: Date:

     

    Occasionally, Wooster UMC uses photographs/videos of children/youth in publicity such as newsletters, social media (including Facebook, Twitter, and Instagram), and on the church websites. No last names will be used on the internet. Please check one of the options below and sign underneath:

    I give permission for Wooster UMC to use my child’s picture/video in public materials.Please do not include my child’s picture/video in any publicity.

    Parent/guardian signature*: Date:

     

    We could use your help! We welcome and encourage parent involvement in our Children’s Ministry activities! Some options are available below - check if you’re interested, someone will get back to you with details (no obligation)!

    Christmas PageantCraft Prep VolunteerVBSSunday School Kick OffKidMin Planning TeamSunday School Helper