Children's Registration - St. Paul's United Methodist Church, Cedar Rapids, Iowa

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St. Paul's Kids Registration

Dear Parent/Guardian: Please fill out the information below along with the medical release information for each child involved with activities at St. Paul's United Methodist Church. If any information changes throughout the year, please let us know. It is very important to have this information to keep records up to date.

Child's Full Name
Street Address:
City State Zip Code:
Child's Birthday:
Grade in School:
Contact Information
This will be our primary form of contact for parents/guardians and child.

Parent/Guardian Name (1):
Parent/Guardian (1) Home Phone:
Parent/Guardian (1) Cell Phone:
Parent/Guardian (1) Email:

Parent/Guardian (2) Home Phone:
Parent/Guardian Name (2):
Parent/Guardian Cell Phone (2):
Parent/Guardian Email (2):

Baptism Information

The United Methodist Church honors and accepts all forms of baptism from all denominations. A service of baptism will be a part of the confirmation service for those who have not been baptized.

Our child has been baptized

Our child has not been baptized

Current Church Membership Information

We are members of St. Paul's UMC

We are members of:

Name of Church

We are not currently members of a church

Media Release

We do allow photos and videos to be taken of our student and used for St. Paul's UMC Promotions and social media.

We do not allow photos and videos to be taken of our student and used for St. Paul's UMC promotions and social media.

Medical Information

For the use of retreats and field trips.

Child's Full Name:

Date of Birth:

Emergency Contact Name & Phone Number:

Street Address:

City/State/Zip Code

Is child covered by health insurance?

yes

Insurance Company Name & Policy Number

Policy Holder Name

Policy Holder Relationship to Student

Current Medications:

Medical History

Please check all boxes that apply if you have had any of the following conditions.

Asthma	Seizures
Fainting	Sleep Walking
Hearing Impaired	Vision Impaired
Back Pain	Heart Condition
Chronic Illness	Diabetic
Psychological Disorder (anxiety depression etc.)

Please explain any checked conditions:

Do not enter anything in this field:

Submit

St. Paul's United Methodist Church
1340 3rd Ave SE
Cedar Rapids, IA 52403
319.363.2058

Office Hours:
Monday-Thursday | 9:00 am-4:00 pm
Friday | 9:00 am -12:00 pm

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Sunday
9:00 am | Traditional
11:15 am | Worship Café
1:00 pm | African Nationals

Saturday
5:30 pm | African Nationals