First United Methodist Church of Belmont
Emergency Information/Permission Form
Active dates August 1 2021, 2021-August 21, 2022
Sign in to Google to save your progress. Learn more
Email *
YOUTH CONTACT INFORMATION
Youth Last Name *
Youth First Name *
Date of Birth *
MM
/
DD
/
YYYY
Grade *
Required
School *
Youth Cell Phone
Can this student receive text messages from the Director of Youth Ministries, and volunteer adult youth leaders that have completed their annual Safe Sanctuaries Training? *
Youth Email Address
Youth Street Address *
City, State and Zip Code *
Youth Home Phone Number
PARENT/GUARDIAN CONTACT INFORMATION
Name of first parent (who is to be contacted FIRST when needed) *
First Parent Cell Phone *
First Parent Email Address *
Name of Second Parent
Second Parent Cell Phone number
Second Parent Email Address (only include if you want this email added to the database)
EMERGENCY CONTACT INFORMATION
Information informs us of who to contact if the First and/or Second Parent cannot be reached during the event of an emergency.
Contact in case of emergency (when parents cannot be reached) *
First and Last Name
Phone number for emergency contact *
YOUTH MINISTRY CONTACT INFORMATION
Please provide the preferred email address to be used for Constant Contact.  This will provide you with weekly updates of the happenings in Youth Ministry.
If so desired, include a secondary email address to be used for Constant Contact.  This will provide you with weekly updates of the happenings in Youth Ministry.
Please provide the preferred cell phone to be used for EZ text.  This will provide you with last minute reminders or changes in Youth Ministry.
If you would like for your child participating in Youth to receive text updates for events and sign ups, please include their cell phone number here.
If you desire, provide an additional cell phone to be used for EZ text.  This will provide you with last minute reminders or changes in Youth Ministry.
INSURANCE INFORMATION
Name of your Insurance Company *
Policy Number *
Group Number *
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of United Methodist Church. Report Abuse