Summer Registration 2019 - Rolling Hills United Methodist Church

Each child must be registered here before choosing their class schedule options.

Family Last Name*
Child's Name
First Last
Please list all siblings attending RHUMC Summer Camps with this child
Child's Gender*
- Male
- Female
Child's Date of Birth*
Grade in Fall 2019*
School*
Any Allergies, Medical Conditions, or Special Accommodations?*
- Yes
- No
Describe Allergies, Medical Conditions, Special Accommodations*
Children's Primary Home Address*
Street Address Address Line 2 City State ZIP Code
Home Phone*
Contact Email*
Parent #1 Name*
First Last
Parent #1 Work Phone*
Parent #1 Cell Phone*
Parent #2 Name*
Parent #2 Work Phone*
Parent #2 Cell Phone*
Emergency Contact Name*
Emergency Contact Phone*
List other persons authorized to pick up your child (Name and Phone):
Please list the type of Sunscreen (you must provide it each day) and Child Name(s)*
Check here if you have read and agree to the terms of enrollment:*
- Yes
As the parent or authorized representative, I hereby give consent to Kid Zone of Rolling Hills United Methodist Church to obtain all medical or dental care prescribed by a duly licensed physician (M.D.), osteopath (D.O.), or dentist (D.D.S.), for the above named child. This care may be given under whatever conditions are necessary to preserve life, limb or well-being of the child named above. Photos and videos may be taken of my child for display, publicity, and in-house activities.
Name of Consenting Guardian*
First Last
Child's Cell Phone
Do you have special requirements for sunscreen?*
- Yes
- No
Photo Consent*
May we use a photo of your child in social media?
- Yes, you may use a photo of my child in social media.
- No, do not use photos of my child in social media.
Primary Emergency Contact Name / Phone*
Please indicate which parent and which phone we should contact first.
Unique ID

Rolling Hills United Methodist Church

Sunday Worship