Holy Covenant United Methodist Church

Children and Youth Choir Registraition Form

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Name

Sex	Male Female

Date of Birth

Please Choose	Bells Choir Bells & Choir

Grade Entering in Fall 2008

Age (as of Sept. 1)

School District

Parent/Legal Guardian

Home Phone

Work Phone

Cell Phones

Parent Email/s

Child's/Youth Email

Street Address

City

Zip

List all adults authorized to pick up your child. Name/Relation/ Phone

Emergency Contact other than Parent/Relation/Phone

Allergies or other conditions that may limit activity

Special Needs (Include any challenges to learning)

Physician's Name

Physician's Phone Number

Registration Submitted By:

Date

I give permission for my child to be photographed for the sole use of Holy Covenant UMC *	Yes No

I have read the legal waiver and I agree to its contents. *	Yes No

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