Canvas Jr

COST: $15 per family.

STEP 1: Please complete one registration form per child.

CHILD INFO

Child's First Name

Last Name

Gender

Birthdate

Age (on the first day of camp)

Upcoming Grade (2018-19)

Upcoming School (2018-19)

Tshirt Size

PARENT/GUARDIAN INFO

Parent/Guardian Attending

Cell

Who's Number Is This?

Parent/Guardian Attending

Cell

Who's Number Is This?

Home Phone

Parent/Guardian Email **used for communication and confirmation emails - check for typos**

Retype Email

ADDRESS

Address

City

State

Zip

CHILD MEDICAL INFO

Not Applicable

N/A

Allergies/Medical Needs (medical/dietary/physical needs)

EMERGENCY INFO

Emergency Contact Name

Relationship

Phone

*PHOTO/VIDEO RELEASE

For privacy and safety, we will not publish names with photographs/videos.
I authorize the use/release of photographs and/or videos that include the INDIVIDUALS NAMED ABOVE for UCUMC use, in print and electronic materials (worship videos, e-mail blasts, church website, Facebook, etc.).

Photo/Video Release:

Given

Denied

*RELEASE

Submitting this on-line form will be the equivalent of signing a paper registration form.

I have read and understand the above information. The information I have given UCUMC is accurate and true to the best of my knowledge.
My electronic signature signifies my understanding that submitting this online form will be the equivalent of signing a paper registration form.

Release

Yes, I agree

Parent/Guardian Electronic Signature

Date Electronically Signed

Payment via

Online

Check

Due upon registration.

Person making payment (if other than parent)

When this form is processed, you will receive a confirmation email with payment instructions. Thank you!

2018 Canvas Jr Registration - ChildUCUMC | July 9 - 11 (3 days only) | 9-11:30am

2018 Canvas Jr Registration - Child
UCUMC | July 9 - 11 (3 days only) | 9-11:30am