REGISTER

COST: $5 per family

Pick a date:

Parent Information

Parent's Name

Phone

Cell

Email Address


SNACK or DESSERT DONATION (optional):
Yes, a packaged snack (chips, pretzels, popcorn, goldfish, animal crackers)
Yes, a packaged dessert (animal crackers, cookies, popsicles)


1st Child/Teen

Child/Teen's Name

Age

Grade

Allergies?

PHOTO/VIDEO RELEASE
For privacy and safety, we will not publish names with photographs/videos.
I authorize the use/release of photographs and/or videos that include the INDIVIDUAL NAMED ABOVE for UCUMC use, in print and electronic materials (worship videos, e-mail blasts, church website, Facebook, etc.).

Photo/Video Release Given
Photo/Video Release Denied


2nd Child/Teen

Child/Teen's Name

Age

Grade

Allergies?

PHOTO/VIDEO RELEASE
For privacy and safety, we will not publish names with photographs/videos.
I authorize the use/release of photographs and/or videos that include the INDIVIDUAL NAMED ABOVE for UCUMC use, in print and electronic materials (worship videos, e-mail blasts, church website, Facebook, etc.).

Photo/Video Release Given
Photo/Video Release Denied


3rd Child/Teen

Child/Teen's Name

Age

Grade

Allergies?

PHOTO/VIDEO RELEASE
For privacy and safety, we will not publish names with photographs/videos.
I authorize the use/release of photographs and/or videos that include the INDIVIDUAL NAMED ABOVE for UCUMC use, in print and electronic materials (worship videos, e-mail blasts, church website, Facebook, etc.).

Photo/Video Release Given
Photo/Video Release Denied


4th Child/Teen

Child/Teen's Name

Age

Grade

Allergies?

PHOTO/VIDEO RELEASE
For privacy and safety, we will not publish names with photographs/videos.
I authorize the use/release of photographs and/or videos that include the INDIVIDUALS NAMED ABOVE for UCUMC use, in print and electronic materials (worship videos, e-mail blasts, church website, Facebook, etc.).

Photo/Video Release Given
Photo/Video Release Denied


RELEASE: Submitting this on-line form will be the equivalent of signing a paper registration form.
Agree
Disagree

Name of Adult filling out this form:

Date Electronically Signed



 
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