J-Walkers Registration Form

J-Walkers Registration Form
Child's Full Name*

First NameMiddle NameLast Name
Parent/Guardian Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Emergency Contact Name*
Relationship to child
Emergency Contact Phone Number*

Area CodePhone Number
What school does the child attend?*
School Grade in 2024 - 2025 school year?*
Will the student be transported from school to FUMC by parents or is transportation required?*
Please list any allergies or health conditions (IT IS IMPORTANT TO NOTE ANY FOOD ALERGIES AS CHILDREN HAVE SNACKES EACH WEEK!):*
Photos/Videos of your child may be used in our church publications, both printed and electronic. Please indicate if you give permission for photos/videos of your child to be used.*
By signing below, I give the named child permission to attend J-Walkers at First United Methodist Church. I agree tha the church is not liable for any injuries that occur with the named child is in attendance.
Parent Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty: