Form

Address *

Mobile Number *

- Area Code Phone Number
E-mail *
Child #1 *

First Name Last Name
Child #1 DOB *

- Month - Day Year
Date
Allergies/Medical *
Child #2

First Name Last Name
Child #2 DOB

- Month - Day Year
Date
Allergies/Medical
Child #3

First Name Last Name
Child #3 DOB

- Month - Day Year
Date
Allergies/Medical
Child #4

First Name Last Name
Child #4 DOB

- Month - Day Year
Date
Allergies/Medical
Child #5

First Name Last Name
Child #5 DOB

- Month - Day Year
Date
Allergies/Medical
Child #6

First Name Last Name
Child #6 DOB

- Month - Day Year
Date
Allergies/Medical
If no medical release on file, please submit here or bring with you

Browse Files
Medical Release available at foundationumc.org/ministries/children Cancel of
Registration Fee

USD You may pay in person via check or exact change, or you may submit your payment now via PayPal. The cost is $20 for 1 child; $25 for 2 children; or $30 for 3 or more children from the same household. Please adjust accordingly before clicking submit below.
Should be Empty:

June 1, 2018 5:30pm-9:30pm