Children's Registration Form for St. John's Ivyland (2022-2023)
September 11, 2022 - June 11, 2023 (2022-2023)
All children (birth-sixth grade) participating in activities at St. John's UMC Ivyland must complete a registration form annually.  This form can be used for any of our children's ministry activities including Sunday school, choirs, and children's worship.  

Please complete one form for each child in your family.

* Required


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Email *
Child's First Name *
Child's Last Name *
Child's Date of Birth *
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DD
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Child's Grade Level for the 2022-2023 School year *
Does your child have any existing medical condition(s)? *
Required
If you answered "Yes" above and your child has an existing medical condition(s), please identify
Does your child have any allergies? *
If you answered "Yes" above and your child has allergies, please identify
Home Address *
Full Name of Parent(s) or Guardian(s) *
Home Phone Number *
Cell Phone Number
What is the best number to reach you in case of an emergency?
If you can't be reached, who should we call in case of emergency?  Please provide full name and best phone number to reach them if there is an emergency.
What would be important for the teachers to know about your child?  What is one thing that would help make this year the best for your child?
I give  permission for my child to participate in activities sponsored by St. John's UMC of the Eastern Pennsylvania Conference of The United Methodist Church. *
What school district are you in?
I give permission to St. John's UMC Ivyland for my child to be photographed for use within the St. John's UMC Ivyland community, including website and social media platforms. *
The following person(s) has my permission to pick up my child from a St. John's activity or event. *
I hereby authorize event staff to obtain and give consent for medical treatment for my child for such injury or illness that may occur during any St. John's UMC sponsored event and hold the event staff and their representatives harmless in the exercise of this authority.  I give my permission as Guardian for my child to be transported in vehicles operated by the adults in whose care the minor has been entrusted while attending and participating in the events.  It is my understanding that my child will be covered by my personal medical insurance.  The event provides limited/supplemental medical payment coverage for injuries arising out of the event activities which is payable in excess of any other collectible insurance.  Payments of any medical injuries not covered by my insurance or the event limited/supplemental medical insurance will be paid by me. *
Please provide name of medical insurance carrier and group number. *
BEHAVORIAL AGREEMENT:  At St. John's UMC, we believe that all people are loved by God.  In response to God's love for us, we need to show love and respect for ourselves and others.  Our behavior should reflect this love and respect and include these qualities:  Patience, Honesty, Kindness, Generosity, Cooperation, Gratitude and Self-Control.  Should a situation arise where behavior of a my child disrupts classroom activities, my child will be removed from the situation.  Inappropriate behavior towards another individual, church property, vehicles, the property of another individual or churches we may visit during an event may result in my child being financially liable for their actions.  In the event of property damage, my child and I agree to reimburse all damages caused by my child.  Should it be necessary for my child to return home from a St. John's UMC event that takes place off premises, due to medical or disciplinary reasons, prior to the end of an event, I, the undersigned, shall assume all transportation responsibility and costs. *
VERIFICATION:  I have read all of the information on this form.  By filling in my name below, I verify that all information on this form is true and accurate *
A copy of your responses will be emailed to the address you provided.
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