Register

Please register me for the following class (click on the box to select the class you’ll attend):

Encounter the Spirit by Carolyn Moore; 8 weeks

Dates: Begins September 1
Time: 9:45 am–12 noon
Contact: Cathy McIlroy (407.366.2692; bcmcilroy@bellsouth.net )
Cost: materials $15 (book)
Childcare:
Childcare available, advanced reservation required.
Description: Encounter the Spirit by Carolyn Moore; 8 weeks


Name:

Spouse:

Children & Ages:

Address:

City, Zip:

Email:

Home Phone:

Cell Phone:

Emergency Contact & number:

Birthday:

Married Single Widowed

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


How did you hear about Bible Study?


Nursery/Childcare required?
yes no (if yes, please fill out below info)


1st Child

Child's Name

Age

Birthday

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

Child's Name

Age

Birthday

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

Child's Name

Age

Birthday

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


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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