Phone number *
Phone type Mobile Home Work Other
I understand my children's images (without name identification) may be published on the Park Avenue UMC Church online or print publications: *
Do any of your children need special accommodations for a medical diagnosis, learning difficulty, disability, etc? *
If yes, please know that we want to be resource for you and your family! We strive to provide a loving environment that is safe and fun for your child. We ask that you stay at the church and be available by text if needed during programming. We also want you to share with us any prayer requests and ways we can assist your family.
I would be interested in serving in the following ways (click all that apply!) *
Liability Release: *
In consideration of Park Avenue United Methodist (PAUMC) allowing the child participate in Children’s ministry activities, I hereby release, forever discharge and agree to hold harmless Park Avenue United Methodist Church, its directors, employees, volunteers and agents (collectively herein the “Church” or “PAUMC”) from any and all liability, claims or demands for accidental personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the Participant while involved in the children's activities, excluding gross negligence or intentional misconduct.
Backup Emergency Contact (Please include name, relationship, and phone number): *
Child #1 Grade *
Select… Early Childhood Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade
Child #2 Grade
Select… Early Childhood Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade
Child #3 Grade
Select… Early Childhood Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade
Child #4 Grade
Select… Early Chilhood Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade
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