SDC – Winder First United Methodist Church

Name

First

Last

Child's Date of Birth

What Name Does the Child Go By?

Will the a

Which Grade Will the Child Complete in May 2025?

Will the Child have any Siblings Also Attending Summer Day Camp? (Please fill out a separate form for each child you are registering)

Mailing Address (Include Street, City & Zip Code)

Parent Name

Parent Email Address

Parent Phone Number

Parent Name

Parent Email Address

Parent Phone Number

Emergency Contact #1 - Please include Name, Relationship to Family & Phone Number

Emergency Contact #2 - Please include Name, Relationship to Family & Phone Number

The following people may also pick up my child from Day Camp (other than listed parents & emergency contacts). ID WILL BE CHECKED. Please include Name, Relationship to Family & Phone Number.

Allergies & Special Instructions (Allergies, Diet, Medical, Behavioral, Extraordinary Circumstances) BE SPECIFIC

If you have a church membership, where is it?

Electronic Signature (Please Type Out Full Name)

My signature acknowledges that In placing my child in this program being offered at Winder FUMC Family life Center, I realize there comes a certain degree of risk of possible injury that might occur from such programming. Therefore, it is understood by me that such a degree of risk exists and I agree to hold Winder First Methodist Church and the Pasley Family Life Center harmless from any claims resulting from injury in the program provided.