Student Information

First Name

Last Name

Birthdate

Phone Number

Grade

Allergies

Conditions/Special Needs

Parent/Guardian Information

First Name

Last Name

Email

Phone Number

Relation to the student(s)

Household Address

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Permissions

Do you give Elberton First Methodist Church permission for photographs or videos to be taken of your child for publications including social media (Facebook, YouTube, Instagram, etc.), church website, bulletins, slideshows, etc.?

Yes

No

Do you give permission for your child to be transported to and from ALL activities, events, retreats or trips sponsored by Elberton First Methodist Church?

Yes

No

*By signing below, I certify that all of the above information is true and correct.

Signature of parent/guardian

Date