Street address (include city, state, and zip code) *
Your answer
Home phone number *
Your answer
Cell phone number *
Your answer
Email address *
Your answer
Emergency Contact: Name *
Your answer
Emergency Contact: Phone number *
Your answer
Allergies or other medical conditions *
Your answer
Dinner will be served at 5:30. We will be serving cheese/pepperoni pizza and salad. Will your child be joining us for dinner? *
I grant to the Rome First United Methodist Church, the right to photograph, audio- or video-record my dependent - in accordance with the Upper New York Annual Conference's Safe Sanctuaries Policy - and to use the photo, audio- or video-recording, or transcript thereof, in the following formats. (Dependent's name will NOT be used.)
-Church newsletter
-Church mailing
-Church bulletin board
-Church website/social media page
-Conference website
-Local/Regional Newpaper
I understand that I can also revoke this permission at any time. (Please check all that apply.)