{"id":6631,"date":"2018-07-21T09:55:59","date_gmt":"2018-07-21T13:55:59","guid":{"rendered":"http:\/\/www.woosterumc.org\/?page_id=6631"},"modified":"2018-07-21T09:55:59","modified_gmt":"2018-07-21T13:55:59","slug":"childrens-information-form","status":"publish","type":"page","link":"https:\/\/woosterumc.org\/new\/childrens-information-form\/","title":{"rendered":"Children&#8217;s Information Form"},"content":{"rendered":"\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f6629-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"6629\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/new\/wp-json\/wp\/v2\/pages\/6631#wpcf7-f6629-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"6629\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.5\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f6629-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/><input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/fieldset>\n<h2>(Birth through Grade 5)\n<\/h2>\n<p><span style=\"color:#FF0000\">*<\/span> Required\n<\/p>\n<p><strong>Today's Date:<\/strong><span style=\"color:#FF0000\">*<\/span>(this Information Form remains valid for one year from today\u2019s date)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"date\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"date\" \/><\/span>\n<\/p>\n<p><strong>Name of Child:<\/strong><span style=\"color:#FF0000\">*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"childname\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"childname\" \/><\/span>\n<\/p>\n<p><strong>Grade:<\/strong><span style=\"color:#FF0000\">*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"grade\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"grade\" \/><\/span>\n<\/p>\n<p><strong>Parent\/Guardian's Name(s):<\/strong><span style=\"color:#FF0000\">*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"parents\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"parents\" \/><\/span>\n<\/p>\n<p><strong>Street Address:<\/strong><span style=\"color:#FF0000\">*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"address\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"address\" \/><\/span>\n<\/p>\n<p><strong>City:<\/strong><span style=\"color:#FF0000\">*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"city\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"city\" \/><\/span>\n<\/p>\n<p><strong>E-Mail:<\/strong><span style=\"color:#FF0000\">*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"email\" \/><\/span>\n<\/p>\n<p><strong>Phone\/Cell:<\/strong><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-text wpcf7-validates-as-tel\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"phone\" \/><\/span>\n<\/p>\n<p><strong>Birthdate:<\/strong><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"birthdate\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"birthdate\" \/><\/span>\n<\/p>\n<p><strong>Age:<\/strong><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"age\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"age\" \/><\/span>\n<\/p>\n<p><strong>Secondary Contact Name\/Phone:<\/strong><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"secondname\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"secondname\" \/><\/span>\n<\/p>\n<p><strong>Where will you be during Sunday School (Worship, Small Group, etc.) and what is the best way<br \/>\nto contact you (call, text, etc.)?<\/strong>\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"SundaySchool\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"SundaySchool\" \/><\/span>\n<\/p>\n<p><strong>Who has permission to pick up your child? (please list all names)<\/strong><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"permission\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"permission\" \/><\/span>\n<\/p>\n<p><strong>Child's allergies:<\/strong><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"allergies\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"allergies\" \/><\/span>\n<\/p>\n<p><strong>Child's special needs:<\/strong><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"specialneeds\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"specialneeds\" \/><\/span>\n<\/p>\n<p><strong>Medical insurance company:<\/strong><span style=\"color:#FF0000\">*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"insurance\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"insurance\" \/><\/span>\n<\/p>\n<p><strong>Policy #:<\/strong><span style=\"color:#FF0000\">*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"policy\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"policy\" \/><\/span>\n<\/p>\n<p><strong>Choice of hospital:<\/strong><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"hospital\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"hospital\" \/><\/span>\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"nameofstudent\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"nameofstudent\" \/><\/span> (name of student) has my permission to participate in the following activities sponsored by Wooster United Methodist Church:\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"activities\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"activities[]\" value=\"Sunday School\" \/><span class=\"wpcf7-list-item-label\">Sunday School<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"activities[]\" value=\"Nursery\" \/><span class=\"wpcf7-list-item-label\">Nursery<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"activities[]\" value=\"Childcare during church functions\" \/><span class=\"wpcf7-list-item-label\">Childcare during church functions<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"activities[]\" value=\"Other\" \/><span class=\"wpcf7-list-item-label\">Other<\/span><\/span><\/span><\/span>\n<\/p>\n<p>&nbsp;\n<\/p>\n<p>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.\n<\/p>\n<p>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\u2019s 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.\n<\/p>\n<p>Parent\/guardian signature<span style=\"color:#FF0000\">*<\/span>: <span class=\"wpcf7-form-control-wrap\" data-name=\"guardiansignature\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"guardiansignature\" \/><\/span> Date: <span class=\"wpcf7-form-control-wrap\" data-name=\"signaturedate\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"signaturedate\" \/><\/span>\n<\/p>\n<p>&nbsp;\n<\/p>\n<p>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. <strong>No last names will be used on the internet<\/strong>. Please check one of the options below and sign underneath:\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"photos\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"photos\" value=\"I give permission for Wooster UMC to use my child\u2019s picture\/video in public materials.\" \/><span class=\"wpcf7-list-item-label\">I give permission for Wooster UMC to use my child\u2019s picture\/video in public materials.<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"photos\" value=\"Please do not include my child\u2019s picture\/video in any publicity.\" \/><span class=\"wpcf7-list-item-label\">Please do not include my child\u2019s picture\/video in any publicity.<\/span><\/span><\/span><\/span>\n<\/p>\n<p>Parent\/guardian signature<span style=\"color:#FF0000\">*<\/span>: <span class=\"wpcf7-form-control-wrap\" data-name=\"guardiansignaturephoto\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"guardiansignaturephoto\" \/><\/span> Date: <span class=\"wpcf7-form-control-wrap\" data-name=\"signaturedatephotos\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"signaturedatephotos\" \/><\/span>\n<\/p>\n<p>&nbsp;\n<\/p>\n<p>We could use your help! We welcome and encourage parent involvement in our Children\u2019s Ministry activities! Some options are available below - check if you\u2019re interested, someone will get back to you with details (no obligation)!\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"activities2\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"activities2[]\" value=\"Christmas Pageant\" \/><span class=\"wpcf7-list-item-label\">Christmas Pageant<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"activities2[]\" value=\"Craft Prep Volunteer\" \/><span class=\"wpcf7-list-item-label\">Craft Prep Volunteer<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"activities2[]\" value=\"VBS\" \/><span class=\"wpcf7-list-item-label\">VBS<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"activities2[]\" value=\"Sunday School Kick Off\" \/><span class=\"wpcf7-list-item-label\">Sunday School Kick Off<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"activities2[]\" value=\"KidMin Planning Team\" \/><span class=\"wpcf7-list-item-label\">KidMin Planning Team<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"activities2[]\" value=\"Sunday School Helper\" \/><span class=\"wpcf7-list-item-label\">Sunday School Helper<\/span><\/span><\/span><\/span>\n<\/p>\n<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Submit Form\" \/>\n<\/p><p style=\"display: none !important;\" class=\"akismet-fields-container\" data-prefix=\"_wpcf7_ak_\"><label>&#916;<textarea name=\"_wpcf7_ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label><input type=\"hidden\" id=\"ak_js_1\" name=\"_wpcf7_ak_js\" value=\"168\"\/><script>document.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );<\/script><\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"ngg_post_thumbnail":0,"footnotes":""},"class_list":["post-6631","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.2 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Children&#039;s Information Form - Wooster United Methodist Church<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/woosterumc.org\/new\/childrens-information-form\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Children&#039;s Information Form - Wooster United Methodist Church\" 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