Wednesday Night Registration

If you have any question please e-mail Darci at youth@hesstonumc.org, or call the church office at 620-327-4305.

Event Registering for

Child's First Name

Child's Last Name

Birthday

Grade:

Parents Name(s):

Address:

City:

Zipcode:

Home Phone:

Work or Cell Phone: (whichever is best during the time of event)

Email

I give permission for my child's photo to be taken and name to be used in publication.

Please type if you AGREE or DISAGREE with the above statement here:

Permission Form & Waiver

I/We hereby give permission for the child stated above to attend any Hesston United Methodist Church activity between January 2013 and April 2013, and to receive transportation for this activity by an adult. I/We release any and all rights or claims for damages against all individuals assisting in instructing and conducting these activities, for any and all injuries, loss, or damage suffered by them, or in any way connected with those injuries. In the event I/We cannot be reached, IN THE CASE OF AN EMERGENCEY, I/We hereby give my/our permission to the physician selected by the sponsor to hospitalize, secure proper treatment for, and/or injections, anesthesia or surgery for the child named above.

Parent or Guardian Name:

By typing your name in the box below, you are providing an electronic signature and are agreeing to the Permission Form & Waiver information above.

Date:

Physician:

Physician Number:

Known Allergens:

Emergency Name & Contact Number:

T-Shirt Size:

Youth Small, Youth Medium, Youth Large,

Adult Small, Adult Medium, Adult Large, Adult XL, Adult XXL

Additional Comments that you would like us to know about:

The suggested donation to cover the cost of meals and supplies is $10.00 per semester. You may make checks payable to HUMC, memo the title of the program. You may mail the check to HUMC P.O. Box 9 Hesston KS 67062, leave in the basket in the church lobby, or have your child bring it with them to the event

Please submit this form below by hitting the Submit Query button below.

Contact the Staff