Bible Club @ 600 Lincoln
PLEASE FILL OUT COMPLETELY FOR EACH CHILD

Wamego United Methodist Church
600 Lincoln Ave. Wamego, KS  66547
785-456-7495  -  renelleaytes@gmail.com
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Child's First Name *
Child's Last Name *
Child's Birthday *
MM
/
DD
/
YYYY
Child's Grade Level *
Does your child need a Bible to keep at home?
Medical (allergies, meds, special needs, etc we should be aware of)
Parent/Guardian Name *
First & Last Name
Current Address *
Street Address, City, & Zip
Parent/Guardian Phone Number *
Parent/Guardian Email *
Alternate Emergency Contact Name *
First & Last Name
Alternate Emergency Contact Phone # *
Individuals Authorized to Pick Up Child *
Liability Release: *
I understand my child may participate in physical activities. As with any activity, there is a risk of injury. I fully accept this risk and hold harmless from any legal liability, Wamego United Methodist Church and any persons involved in Bible Club.
Medical Release: *
In the event of an emergency that requires medical treatment for my child, I understand that every effort will be made to contact me or my emergency contact. However, if we are unavailable, I give my permission for the Bible Club volunteers to secure the services of a licensed physician to provide necessary care for my child. I assume responsibility for all costs connected to any accident or treatment of my child.
Travel Release: *
I grant permission for my child to travel to/from Bible Club events with an adult leader. Any such event will be communicated with me beforehand.
Photo Release: *
I grant permission for photos of my child taken during Bible Club to be released in print and electronic promotion.
Parent's Electronic Signature:  (by typing your name, you are authorizing the above information is correct) *
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