Children Registration

Please fill out this registration and release form with your child's information to register them for LAUMC's Children Programs.

*First Name

*Last Name

*Email Address

*Phone Number

*Address Line 1

Address Line 2

*City

*State/Province/Region

*Zip/Postal Code

*Date of Birth:

*Gender:

*Current Age/Grade:

*LAUMC has my permission to use my child's image in church media.

YesNo

Parental/Guardian Information

*Parent/Guardian 1 First and Last Name:

*Parent/Guardian 1 Cell Phone:

*Parent/Guardian 1 Email Address:

Parent/Guardian 2 First and Last Name:

Parent/Guardian 2 Cell Phone:

Parent/Guardian 2 Email Address:

People other than parents authorized to pick up your child from Sunday School or other Children's events. (Children will not be allowed to leave with any person without authorization from parent or guardian.)

1st Authorized to Pick Up Contact's Name:

1st Authorized to Pick Up Contact's Phone Number:

1st Authorized to Pick Up Contact's Relationship to Child:

2nd Authorized to Pick Up Contact's Name:

2nd Authorized to Pick Up Contact's Phone Number:

2nd Authorized to Pick Up Contact's Relationship to Child:

Medical Information

List any allergies or dietary restrictions:

Medications, chronic Illnesses, or other medial conditions of which we should be aware:

*If a medical or dental emergency should arise while my child is at Sunday School or other Children's Event and I cannot be contacted, I hereby give permission to the director and/or staff of Los Altos United Methodist church to order treatment for my child.

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Children Registration

Please fill out this registration and release form with your child's information to register them for LAUMC's Children Programs.

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