OUMC Registration Form for Avenue941 - T/Th 2:30-6pm 
MASH Unit at Oneco United Methodist Church Fall 2022 -  This form must be completed for each student individually. 
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Where or from whom did you hear about this opportunity? *
Parent of Guardian's First Name *
Parent or Guardian's Last Name *
Relationship to the student *
Parent or Guardian's Phone Number *
Parent or Guardian's Email Address *
The best way to reach me is *
What is/are the names of the adult(s) who will be picking this student up after homework help? *
Student First Name *
Student Last Name *
Student Grade Level *
Student Birthday *
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DD
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Student School Name *
By registering your child, you give permission to us to access FOCUS to monitor grades and school work. We will need your student's FOCUS log-in information so that we can help them log in to complete their work. Type username here (sometimes is the student ID number) *
What is your student's FOCUS log-in PASSWORD? (sometimes is the student six digit bday) *
Is your student able to attend every week on Tuesdays  AND Thursdays (regular attendance is required). *
Does your student have transportation or a way to and from Oneco United Methodist Church? (Arrangements are made for student from Oneco Elementary to walk across the street with one of our staff members at 3:15 from the school). *
We often provide snack and/or dinner. Does your student have any food allergies that we should be aware of? *
Does your student need any medication or have any medical issues or health concerns that we should be aware of?
What does your student need most from a program like this in your opinion? *
Please check off any other services your family may need and we will do what we can to help.  *
Required
I confirm that my student will adhere to the School District Code of Conduct while attending this program. *
Required
I understand that this is a faith-based program with Christian values, that I am granting access to FOCUS and that my student may have pictures and videos taken of them as part of community building and social media. *
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