Treasure Seekers Fall 2025 Registration Form

Fall 2025 Registration Form

Ages: K through 5th grades
1. Childs Name
Grade in 2024 school year
2. Childs Name
Grade in 2024 school year
3. Childs Name
Grade in 2024 school year
4. Childs Name
Grade in 2024 school year
Parent/Guardian contact information: Name(s):
Names
Address
Home Phone
Parent/Guardian #1 Cell Phone
Parent/Guardian #2 Cell Phone
Parent/Guardian #1 Email
example@example.com
Parent/Guardian #2 Email
example@example.com
Any special information we need to know about your childchildren allergies extra support needed
Treasure Seekers will end at 5:15pm. The following people have permission to pick up my children besides myself. Please provide name and contact info.
I give permission for my child to be walked or driven from Lakeview Elementary School to Solon UMC (by volunteers or staff who have background checks), or to a local mission activity within Solon.
Date

MonthDayYear
Date
I give permission for my child/children to be photographed or videotaped during the program:

YesNo
Signature

Clear
$20 fee for one child/$35 for two children in one family/$45 max for one family/scholarships available Make checks out to: Solon UMC, and mail this form to: Solon UMC, 122 N West St., Solon, IA 52333
Thank you!

Dee Swartzendruber, Christian Education Director

deeswartz@soloniaumc.org

319-631-0671
Medical Information and Treatment Release Form
1. Name of child/youth
1. Age/Birth Date

MonthDayYear
Date
1. Name of Parent/Guardian
1. Previous Illness or Injury that may affect child's participation:
1. Current Medications that may affect child's participation:
1. Last date of tetanus booster

MonthDayYear
Date
2. Name of child/youth
2. Age/Birth Date

MonthDayYear
Date
2. Name of Parent/Guardian
2. Previous Illness or Injury that may affect child's participation:
2. Current Medications that may affect child's participation:
2. Last date of tetanus booster

MonthDayYear
Date
3. Name of child/youth
3. Age/Birth Date

MonthDayYear
Date
3. Name of Parent/Guardian
3. Previous Illness or Injury that may affect child's participation:
3. Current Medications that may affect child's participation:
3. Last date of tetanus booster

MonthDayYear
Date
4. Name of child/youth
4. Age/Birth Date

MonthDayYear
Date
4. Name of Parent/Guardian
4. Previous Illness or Injury that may affect child's participation:
4. Current Medications that may affect child's participation:
4. Last date of tetanus booster

MonthDayYear
Date
Family Doctor
Contact Information
Family Dentist
Contact Information
Hospital Preference
The undersigned parent(s)/guardian authorized the Solon United Methodist Church to secure medical/dental treatment forin the event of any illness or accident for which Name of child/youth responsible adults of first aid personnel feel professional medical attention is required. I/We hereby give permission to the administration of any and all necessary medical/dental treatment by a licensed physician or dentist in his/her office or at a hospital.
ParentsGuardian Signature

Clear
Date

MonthDayYear
Date
*If registering more than one child, please copy this side and fill out one Medical Information form for each child*
Should be Empty: