Open Heart UMC Youth & Child Registration 2024-25

Today's Date*

Please enter the date of filling out the form

Parent / Guardian Information

1st Parent / Guardian Name*

Please enter your legal first and last name, and add (preferred name) if needed.

1st Parent / Guardian Cell Phone Number*

1st Parent / Guardian Residential Address

2nd Parent / Guardian Name

Please enter the legal first and last name, and add (preferred name) if needed, of a second adult responsible for children in the family.

2nd Parent / Guardian Cell Phone Number

2nd Parent / Guardian Residential Address

If different from 1st Parent / Guardian

School-Aged Dependent(s) Information

Please tell us about the kid(s) in the family, attending school grades K-12

1st Child Info*

Please enter their 1) first and last name, and preferred name in parentheses, followed by their 2) age and 3) grade. Ex. Andrew Smith (Andy), 10 yrs, 5th grade.

Child 1 special needs*

Does this child have any food allergies, physical limitations, etc. of which we need to be aware?

Yes

No

Child 1 itemized issues

If YES, please specify those issues for our team's awareness

2nd Child Info

Please enter their 1) first and last name, and preferred name in parentheses, followed by their 2) age and 3) grade. Ex. Lauren Smith (Lori), 9 yrs, 4th grade.

Child 2 special needs

Does this child have any food allergies, physical limitations, etc. of which we need to be aware?

Yes

No

Child 2 itemized issues

If YES, please specify those issues for our team's awareness

3rd Child Info

Please enter their 1) first and last name, and preferred name in parentheses, followed by their 2) age and 3) grade. Ex. Liam Smith, 8 yrs, 3rd grade.

Child 3 special needs

Does this child have any food allergies, physical limitations, etc. of which we need to be aware?

Yes

No

Child 3 itemized issues

If YES, please specify those issues for our team's awareness

4th Child Info

Please enter their 1) first and last name, and preferred name in parentheses, followed by their 2) age and 3) grade. Ex. Addison Smith (Addy), 7 yrs, 2nd grade.

Child 4 special needs

Does this child have any food allergies, physical limitations, etc. of which we need to be aware?

Yes

No

Child 4 itemized issues

If YES, please specify those issues for our team's awareness

5th Child Info

Please enter their 1) first and last name, and preferred name in parentheses, followed by their 2) age and 3) grade. Ex. Amber Smith (Birdie), 6 yrs, 1st grade.

Child 5 special needs

Does this child have any food allergies, physical limitations, etc. of which we need to be aware?

Yes

No

Child 5 itemized issues

If YES, please specify those issues for our team's awareness

More about their world...

Siblings youger or older than school-age

Please enter name and age of siblings who have not yet started school, or have already graduated from high school.

Pets

Name and type (Ex. Mittens, cat)

Interests

Please share more with us about their interests. What gets them excited? What are they happy to do and think about? Please note their name if an interest is specific to an individual and you've listed more than one.

Faith questions*

Are you aware of any particular faith questions or topics of interest your child(ren) has shared with you recently, or that you hope we will address? (ex. who and how God is, why are we here, prayer, the bible, dealing with peer pressure, why Jesus matters, etc.) AND / OR Why is it important for YOU that they are part of a children's / youth program?

Imagery Permission

Photo/Social Media permission*

Do we have your permission to take photos / videos of your dependents during church programming and share on social media, via email, and/or in print to further increase awareness of Open Heart UMC and what is offered here?

Yes

No

Signature*

I agree that by typing my name below, I am giving or denying permission for photo usage of my dependents for the next 12 months.

Send me a copy of my responses