Please fill out one form for each child in the family.
Date of Birth & Grade
Please provide MM/DD/YYYY and current grade.
Please include street address, city, state, and zip code.
Please include home, work, and cell phones.
Emergency Contact Name & Relationship
For use when parent cannot be reached.
Emergency Contact Phone Numbers
Medical Information Part I
Please include current medications (including dosage), allergies, and any special needs.
Medical Information Part II
Please include doctor's name, doctor's phone number, and preferred hospital.
Please include insurance company, insured's name, and insurance card policy number.
Electronic Signature for Participation
By typing your name below, you agree to the following statement: I give permission for the child named above to participate in field trips and transportation with Asbury UMC's Children's Ministries during 2016-2017. Permission is also granted for the staff of AUMC to seek medical treatment for my child listed above, if necessary, while participating in Sunday School/KIDS KLUB functions. I understand that all precautions will be taken for my child's safety. I will not hold the church, its staff, or those supervising liable. I give permission for the staff of AUMC to give my child ibuprofen, acetaminophen, or Benadryl if the need is to arise.
For the necessity of allowing children to ride the church van or in a volunteer's vehicle to and from school, or other church related functions, please clearly indicate the permissions that apply to your child or dependent. (Check all statements that apply.)
If your child needs transportation from school on Wednesday afternoon, please indicate the school's name.
Electronic Signature for Transportation
By typing your name below, you give permission for your child to ride the church van or in a volunteer's vehicle on Wednesday afternoons from their school.