Middle School Bible Club Registration

First United Methodist Church of Belle Vernon

Middle School Bible Club at

Belle Vernon Middle School Registration

Every Tuesday starting on September 24

after school 3PM-5PM

Belle Vernon Middle School

500 Perry Avenue, Belle Vernon, PA 15012

(One Registration form needed per family)

Required *

Child's Name

Current Grade

Birthdate

Age

Second Child's Name

Current Grade

Birthdate

Age

Third Child's Name

Current Grade

Birthdate

Age

Fourth Child's Name

Current Grade

Birthdate

Age

Fifth Child's Name

Current Grade

Birthdate

Age

Parents/Guardians Name

Address

City

State

zip

Home Phone

Cell Phone

Email Address

IN THE EVENT OF AN EMERGENCY, I authorize FUMC Church/Belle Vernon Middle School to contact the following people. If I am unable to pick up my child, I give permission to the following people to pick up my child and I will inform them as such.

Emergency Contact 1 Home Phone:

Emergency Contact 1 Cell:

Emergency Contact 2 Name

Emergency Contact 2 Home Phone:

Emergency Contact 2 Cell:

Emergency Contact 3 Name:

Emergency Contact 3 Home Phone:

Emergency Contact 3 Cell:

Special Needs/Allergies

I hereby give permission for my child to attend and participate in Belle Vernon First Methodist Church (FUMC) Middle School Bible Club Program.

I give permission for any and all emergency medical treatment necessary in the event of an accident or illness during Bible Clubs at Belle Vernon Middle School.

I release FUMC and its people from liability in case of an accident

I expect to be contacted if medical attention is necessary

I give permission for photos to be taken of my child while in attendance at FUMC's Middle School Bible Clubs.

I give permission for photos of my child to be used by FUMC for advertising the Middle School Bible Clubs. I understand children's names will not be used in conjunction with the photos.

By clicking Submit, this action is my Electronic Signature in adhearance with all State and Local laws as of the date submitted.

First UMC