NorthStar United Methodist Church / Children & Youth / Summerblast

We're so excited for your child to join us at SummerBLAST!! So we can be sure to have enough supplies, please fill in the form below to register your child. Up to 3 children from the SAME family can be registered on this form.

1. Child's Name (first & last name):

Male

Female

Date of Birth:

Age :

Grade entering:

Special Needs or Concerns (i.e., allergies, fears, etc):

Would your child like to be with a friend? If so, please list the name of the friend below.

2. Child's Name

Male

Female

Date of birth:

Age

Grade entering:

Special Needs or Concerns (i.e., allergies, fears, etc):

Would your child like to be with a friend? If so, please list the name of the friend below.

3. Child's Name:

Male

Female

Date of Birth:

Age:

Grade entering:

Special Needs or Concerns (i.e., allergies, fears, etc):

Would your child like to be with a friend? If so, please list the name of the friend below.

Parent(s) Name:

Phone number where you can be reached during event:

Email:

Please enter your full address:

Street Address

City

State

Zip Code

Home church:

Other adults authorized to pick up child:

Adults NOT authorized to pick up child:

How did you hear about SummerBLAST? (please check all that apply)

Friend

May Days

Facebook

Reading Eagle

Yard Signs

Other (please specify below)

NORTHSTAR UMC CHILDREN'S MINISTRY PHOTO/ VIDEO PERMISSION SLIP

From time to time, NorthStar United Methodist Church takes pictures and videos during our church activities. We would like your permission to use these photos in print or online promoting the church's activities. We will not provide any specific information regarding your child without your permission. This permission form will be kept on file and you may withdraw your permission at any time.

YES, I give permission to use photos or videos of my child(ren) for NorthStar UMC purposes.

NO, Please do not use any photos or videos of my child(ren).

Child(ren)'s Name(s) - for purposes of photo/video permssion slip:

Parent/Guardian 's Name - for purposes of photo/ video permission slip:

Parent/Guardian's Signature: (You will be asked to physically sign this form when you drop off your child.)

Date - for purposes of photo/video permission slip:

Additional Information:

Please click button below to complete and send your registration. Thank you for registering!

SummerBLAST 2019 Registration