Rome First UMC Christian Education Registration Form
Please complete one form for each child participating.
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Child's First Name: *
Child's Last Name: *
Age: *
Street Address (include city, state, and zip code): *
Phone Number: *
Email address of parent/guardian: (This will only be used to communicate reminders and information related to Children's Ministry Programming.) *
Emergency Contact Name: *
Emergency Contact Phone Number: *
Please list the First and Last names of any/all adults (including yourself) who have permission to sign-out/pick up your child.

Anyone attempting to sign-out a child MUST be on this list and must be at least 18 years of age or they will not be permitted to leave with the child. *
Allergies or other medical conditions that our team should be aware of: *
Home Church (if applicable): *
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.)
 *
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