Buffalo United Methodist Church Children/Youth Registration 2022-2023
Please complete one form per family. NOTE: Children must be 3 years old by September 1 to register for Sunday School. Sunday @10:00am for Pre-5th grade / Wednesday Youth Nights @6:00pm for 6th - 12th grade.
Child 1
*
First Name
Middle Name
Last Name
Name your child uses (if different from above)
Birth Date
-
Month
-
Day
Year
Date
Gender
Male
Female
Baptized
Yes
No
Church Baptized in
Confirmed
Yes
No
Church Confirmed in
School Grade
Please list any health conditions, allergies, special needs, family situations or social concerns we should be aware of:
Child 2
First Name
Middle Name
Last Name
Name your child uses (if different from above)
Birth Date
-
Month
-
Day
Year
Date
Gender
Male
Female
Baptized
Yes
No
Church Baptized in
Confirmed
Yes
No
Church Confirmed in
School Grade
Please list any health conditions, allergies, special needs, family situations or social concerns we should be aware of:
Child 3
First Name
Middle Name
Last Name
Name your child uses (if different from above)
Birth Date
-
Month
-
Day
Year
Date
Gender
Male
Female
Baptized
Yes
No
Church Baptized in
Confirmed
Yes
No
Church Confirmed in
School Grade
Please list any health conditions, allergies, special needs, family situations or social concerns we should be aware of:
Child 4
First Name
Middle Name
Last Name
Name your child uses (if different from above)
Birth Date
-
Month
-
Day
Year
Date
Gender
Male
Female
Baptized
Yes
No
Church Baptized in
Confirmed
Yes
No
Church Confirmed in
School Grade
Please list any health conditions, allergies, special needs, family situations or social concerns we should be aware of:
Family Information
Father's Name
Father's Cell #
*
-
Area Code
Phone Number
Mother's Name
Mother's Cell #
*
-
Area Code
Phone Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
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Guinea
Guinea-Bissau
Guyana
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Hong Kong
Hungary
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India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Home Phone #
Family E-mail(s)
*
Child(ren) live with
Mother
Father
Other
Names and Phone # of other adults authorized to pick up your child(ren)
Name and description of adult NOT authorized to pick up your child(ren)
Family Volunteer Opportunities
Please check here if there are places you would consider volunteering and someone will contact you:
Teacher
Classroom Helper
Event Helper
Nursery Sub
Event Driver
Parental Permission
Buffalo United Methodist Church has my authorization to act in an emergency situation when I cannot be reached or there will be a delay in my arriving. I understand that all medical costs are the parent or guardian’s responsibility.
I agree
My child(ren) has permission to participate in walking field trips through out year. Field trips requiring transportation will require individual permission forms for each trip.
I agree
I grant permission for my child(ren)’s photo to be taken and/or be video taped. Photos and videos will be used within the program (bulletin boards, teaching materials, etc.) or in promotional materials for the preschool (newspaper, website, flyers etc.). Photos used for public relations will generally not identify any child(ren) by name.
I agree
Electronic Signature
I understand that by checking the "I agree" box that this constitutes a legal signature confirming that I acknowledge and agree to the above.
I agree
Submit Form
Should be Empty: