Participant Registration

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Klein United Methodist Church

Location

5920 FM 2920

Spring, TX 77388

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Contact Megan Smith:

281-353-8202

megan@kleinumc.org

First, tell us about yourself:

Parent Information

First Name

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Last Name

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Address 1

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Address 2

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City

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State/Province

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ZIP/Postal Code

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Contact Phone 1

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Alternative Contact Person

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Alternative Contact Phone Number

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Emergency Contact Person (Not a Parent)

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Emergency Contact Relationship

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Emergency Contact Phone

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Alternate Pick-Up or Drop off Person's Name

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Alternate Pick-Up or Drop Off Person's Phone Number

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Click here for your FREE Friends With God Kids Activity Pack

By checking the box you will be emailed your Free Friends With God Kids Activity Pack.

You are also agreeing to receive emails about family resources from Lifetree. You can unsubscribe at any time. We value your privacy. Your information will not be shared with a third party. Lifetree is a division of Group Publishing, the creators of Group VBS and other faith-building resources. Click to learn more about Lifetree.

Tell Us About Your Participant

First Name

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Last Name

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Name child goes by (if different from first name)

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Date Of Birth

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Current Age

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Gender

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Please choose your child's grade leaving carefully.

Nursery: ONLY if you are volunteering and your child is age 0-3 with a birthday after September 1, 2019.

Pre-School: You child must be at least 3 years old. His/Her birthday must be on or before September 1, 2019.

Kindergarten-Grade 4: If your child is leaving that grade level at the end of the school year.

Grade Leaving

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Shirt Size

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Allergies

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Medical Concerns

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Our buddies for Christ ministry provides children, who may have special needs, the support to be successful and active participants learning about God. Choose the option below if you feel your child would benefit from this program and would like more information.

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Do you have friends you would like to be placed with? We will do our best to group selected friends together in the same crew, but we cannot promise all requests will be possible.

Friend 1 First Name

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Friend 1 Last Name

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Friend 2 First Name

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Friend 2 Last Name

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Friend 3 First Name

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Friend 3 Last Name

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Comments

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READ AND AGREE TO OUR COVID RELEASE OF LIABILITY. YOU MUST AGREE FOR YOUR CHILD TO PARTICIPATE. I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 by attending Klein UMC functions and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at Klein UMC functions may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Klein UMC employees, volunteers, and program participants and their families. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance at Klein UMC or participation in Klein UMC programming. On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless Klein UMC, its employees, volunteers, and representatives, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of Klein UMC, its employees, volunteers and representatives, whether a COVID-19 infection occurs before, during, or after participation in any Klein UMC program.

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I authorize Klein Children's Ministry to photograph or videotape my child during church activities, special events or for photo crafts (which will be distributed to the family only).

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I authorize Klein Children's Ministry to photograph or videotape my child during church activities or special events for use on the Klein UMC website or Klein Children's Ministry Facebook page. No child's name will be used and no family member will be tagged.

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I give permission for my child to recieve basic first aid for MINOR injuries.

Multiple selections are allowed.

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READ AND AGREE TO OUR RELEASE OF LIABILITY. YOU MUST AGREE FOR YOUR CHILD TO PARTICIPATE. KUMC MEDICAL AND LIABILITY RELEASE AND HOLD HARMLESS (YOUTH - UNDER 18) STATE OF TEXAS § COUNTY OF HARRIS § I, the above listed Parent or Guardian make this Medical Power of Attorney and Liability Release and Hold Harmless Agreement on behalf of the above listed minor child, in anticipation of my child's participation in the activities of Klein United Methodist Church ("KUMC"), for the event registered. It is my expectation that my child is and/or will be participating in activities of KUMC, which may include KUMC Youth, Choir, Nursery, Weekday Ministries, Sunday School or other Sunday morning events, and/or any other activities which may occur on or off the KUMC premises, including transportation to and from off premises activities ("KUMC Activities"). In consideration of my child taking part in KUMC Activities, I agree as follows: 1. MEDICAL/POWER OF ATTORNEY ("POA")FOR MINOR CHILD: During the dates identified in this document I recognize that there may be times when my child is participating in a KUMC Activity and I may be unavailable to render decisions on behalf of or care for my child. I, therefore, appoint ANY CLERGY OR STAFF MEMBER of KUMC as my true and lawful attorneys ("my attorney") to do every act and exercise every power that I may or can do or exercise on behalf of my child, and grant my attorney the power to do everything, in my attorney's sole discretion, that may be proper expedient or advisable, and for all intents and purposes, as I might or could do personally, until such time as my unavailability shall end. Without limiting the authority granted, I specifically grant my attorney the authority to seek, obtain, authorize, give, or otherwise get medical, health, dental, and/or emergency care for my child as may be necessary during my unavailability. 2. RELEASE AND HOLD HARMLESS RELATED TO PARTICIPATION AND POA: I (individually and as parent, next friend, or legal guardian) release, indemnify, defend, and forever discharge and hold harmless ("Release") KUMC, its clergy, staff, employees, sponsors, chaperones. volunteers, and committee members individually and in any representative capacity (referred to as "Released Parties" in this document) of and from any and all claims, demands, liability, suits, injuries (including death), attorney's fees, expenses, costs, causes of action, judgments or awards of any kind or character ("Loss") which may accrue because of, arise out of or exist on account of my child's participation in KUMC Activities, or in any way connected with this POA or care given or obtained by and/or through it for my child. This Power of Attorney and Release shall be valid for the registered event.

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