FaithWeaver Friends and Mission Maniacs Registration Form 2007-08

Name   Date of Birth

Address  Grade

City  State  Zip

Phone

Known Allergies

Special Needs

T-Shirt Size: Child Small I already have a shirt that I wear Child Medium Child Large Adult Small Adult Medium Adult Large Adult XLarge Adult XXLarge

Emergency Contact Information

Parent/Guardian Name(s)

Address

City  State  Zip

Phone Numbers

Home Work  Cell

Permission for Mission Maniacs

I, the parent/guardian of give my permission for him/her to ride the Cabot United Methodist Church van or other volunteer vehicle to any of the 2007-08 Mission Maniacs activities.  I release the Cabot United Methodist Church and chaperones from liability.

In case of a medical emergency involving my child(ren), I give the Cabot United Methodist Church permission to obtain medical treatment for my child(ren).  I will be responsible for the physician and/or hospital fees.  I grant permission to any qualified medical facility to administer emergency and/or lifesaving treatment.  I also grant permission to place my child in an emergency vehicle for transportation to the nearest emergency medical facility.

Parent/Guardian Signature             Date