Lil' GUMDROP Registration Form
Grace United Methodist church Draw Read Open Play and Snacks

Registration Fee is $40 for 1st child and $10 each additional child in the same family.

Circle one Session:    Session I  9:00-10:00 a.m.                     Session II  10:15-11:15 a.m.

Child’s Name ___________________________________________     Birthdate____________________

Child’s Name ___________________________________________     Birthdate____________________

Child’s Name ___________________________________________     Birthdate____________________

Parent’s Name ________________________________________________________________________

Mailing Address _______________________________________________________________________

Phone number _________________________________________________________________________

E-mail _______________________________________________________________________________

Allergies, other emotional or behavioral conditions we should be aware of:

______________________________________________________________________________________

______________________________________________________________________________________

Emergency Contact (Name and number) _____________________________________________________

Child’s Doctor and Phone Number __________________________________________________________

Church Affiliation (if any) _________________________________________________________________

Total amount enclosed $______________

PERMISSION FOR MEDICAL TREATMENT/ FIELD TRIPS/ PHOTOGRAPHS

My child(ren) has my permission to participate in special events related to GUMDROPS, including field trips,      

and meetings away from the building in which the group regularly meets.
 

In the event of an injury, the supervising adults have my permission to secure medical treatment for my child(ren)   

if I cannot be reached.  I understand that every effort will be made to reach me before medical treatment is given

to my child except when a delay in treatment would endanger my child’s health.
 

My signature below gives Grace UMC permission to use pictures of the child listed on this form.  Pictures may 
appear on the church web site and/or print media.

Date ________________  

Parent/Legal Guardian Signature_____________________________________________

Please print out and drop off or mail registration form to the church office.