EmailMe Form - 2022-2023 PSJUMC Children's/Youth Registration

Student Name

First Last

Birthday

MM / DD / YYYY

Grade

Physical Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Mailing Address (If not the same)

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

School

Guardian

First Last

Guardian Phone Number

### - ### - ####

Guardian Email

Guardian

First Last

Guardian Phone Number

### - ### - ####

Guardian Email

Facebook Names (for group messaging)

Medical Concerns

Emergency Contact

First Last

Emergency Contact Phone

### - ### - ####

Emergency Contact

First Last

Emergency Contact Phone

### - ### - ####

My child is eligible and has my permission to participate in the FUMC children/youth programs including permission to ride the church bus/vans for pick up after school, church outings and mission work. This activity will take place under the supervision of the employees and volunteers from the First United Methodist Church of Port Saint Joe. Your name below indicates your consent for your student to participate and releases FUMC of liability.

Date

MM / DD / YYYY