FaithWeaver Friends and Mission Maniacs

Fields with a " * " next to them are required.

1. Name *
   
2. D.O.B.: *
   
3. Grade: *
   
4. Address *
   
   
   
5. Phone *
   
   
6. Email *
   
7. Allergies/Medical Conditions: (food & environmental)
   
8. Special Needs:
   
9. T-Shirt Size:
   -- Please Select One -- 2T Child X-Small(2-4) Child Small (6-8) Child Medium (10-12) Child Large (14-16) Child X-Large Adult Small Adult Medium Adult Large Adult X-Large Adult XXL Adult XXX Large Adult XXXX-Large
   I already have a shirt that I will wear
10. 
    
    

    Emergency Contact Information

11. Parent/Guardian Name(s) *
    
12. Address (if Different than child)
    
    
    
13. Home *
    
    Work *
    
    Cell *
    
    
14. 
    
    

    PERMISSION SLIP FOR MISSION MANIACS (ONLY 5TH & 6TH GRADERS NEED TO COMPLETE)

    
    
    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 2009-10 Mission Maniac activities. I release 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.
    
    Signature of Parent/Guardian Date
15. 
    
    

    MEDIA RELEASE

    
    
    I consent that my child may have his/her picture included in any photos taken during the class learning or activity times. Photos can be released to area newspapers, church website or Cabot United Methodist Church publications.
    
    Signature of Parent/Guardian Date




Authentication

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