Impact Student Ministries Registration Information

Impact Student Ministries includes programs for youth in Kindergarten through 12th grades. Activities include, but are not limited to: weekly Impact Group meetings, mission trips, camps, and social events.

Student Information

Name

Nickname / Preferred Name

Gender

Birthdate

Address

Phone

Do you grant student leaders permission to contact your student via text messages or phone calls?

Please select one option.

Yes No

Does the student have any allergies, dietary restrictions or other special needs that are required:

Please select one option.

Yes No

If Yes- please list them here

What is this student's t-shirt size?

Please select one option.

Youth XS Youth S Youth M Youth L Youth XL Adult S Adult M Adult L Adult XL Adult XXL

Does this student require a booster seat?

Please select one option.

Yes No

Parent / Guardian - 1

First Name

Preferred Name

Last Name

Phone Number

Address

Parent / Guardian - 2

First Name

Preferred Name

Last Name

Phone Number

Address

Emergency Contact Information (other than parent/guardian)

Emergency Contact Name

Emergency Contact Phone Number

List other people (including the student, if they are of legal driving age) who are allowed to pick up this student.

Are there other adults who should specifically NOT pick up this student? If so, please list.

Signature

In typing your name here, you are consenting to allow your student to participate in Impact Student Ministries at First UMC El Dorado. Including being transported by church leaders in church vehicles, church approved transportation, including over state lines for church sponsored trips and the use of pictures of your student for celebratory or promotional purposes.

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Impact Student Ministries Registration Information

Description

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