RPUMC Children's Ministry Registration
All children and youth under the age of 18 must have a valid current registration form on file each year to participate in any of the children's ministry activities sponsored by Richardson Park United Methodist Church.  
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Email *
Parent/Guardian Last Name *
Parent/Guardian First Name *
Parent/Guardian Mailing Address *
City *
State *
Zip Code *
Parent/Guardian Cell Phone *
May we text you on this cell phone number? *
Second Parent/Guardian Phone Number
Emergency Contact Name (adult over 18) *
Relation to Child(ren) *
Emergency Contact Phone Number *
Alternate Pick-Up Person 1
Alternate Pick-Up Person 1 Phone Number
Alternate Pick-Up Person 2
Alternate Pick-Up Person 2 Phone Number
Where is your Home Church Affiliation? *
I understand that photographs may be taken during this event and used within the church walls and/or on Facebook. By clicking YES I give permission for my child's image to be used in this way. *
Children Age 12 And Up May Leave Children's Worship Without Parent/Guardian Escort. Do You Agree To Allow Your Child(ren) Age 12 And Up To Leave Children's Church Unaccompanied By An Adult? (Please Note: Children Under Age 12 Will Not Be Permitted To Leave Without Parent/Guardian Escort. Please Note: All Children UNDER The Age Of 12 Must Be Signed Out By A Parent/Guardian, Or Other Designated Adult At The Conclusion of Worship and all other Children's Ministry sponsored events.) *
1st Child Last Name *
1st Child First Name *
Grade Entering in Fall 2021 *
Required
Gender *
Date of Birth *
MM
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DD
/
YYYY
Shirt Size (Y-adult) *
Required
Please list ANY and ALL ALLERGIES for 1st Child or write NONE: *
Please list ANY and ALL MEDICAL CONCERNS for 1st Child or write NONE: *
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