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INFORMATION/RELEASE FORM

Child's Full Name

Grade

Address

Parent / Guardian

Phone # (where you can be reached during CAPS)

Email

Child’s Age

Date of Birth

Does your child have a home church?

Yes

No

If yes, name of church

Name and grade of other children signing up
(Note: a C.A.P.S. Registration form must be completed for each additional child.)

Allergies: Food? (list)

Medicine? (list)

Environmental? (list)

Other Conditions?

Name of child’s doctor

Doctor's Phone #

If in the judgment of any representative of the church, the above person should need immediate care and treatment as a result of any injury or sickness, I do hereby request, authorize, and consent to such care and treatment as may be given said person by any physician, hospital, or church representative; and hereby agree to indemnify and save harmless the church and any church representative from any claim by any person whomever on account of such care and treatment of said person.

Electronic Signature of Parent/Guardian

Date

I give permission for the following people to pick up my child from CAPS:

Electronic Signature of Parent/Guardian

Date

Will the church need to transport your child from school to church?

Yes

No

If so, which school?

TRANSPORTATION PERMISSION FORM

My child (named below) has permission to ride the First United Methodist Church van and/or associated vehicles after school on Wednesday for the CAPS program. I understand that a representative of the church will pick up my child immediately after school. If my child is not able to attend, I will notify the church office during regular hours, 9am to 3pm (512) 556-5513 so that the van does not wait for my child.

Child's Full Name

Teacher’s Name

Room #

Electronic Signature of Parent/Guardian

Date

CODE OF CONDUCT

In all CAPS activities or other events under the sponsorship and/or guidance of the Church, the child is representing the Christian community and we ask that they be re-sponsible for his or her actions. The following guidelines are to be as follows:

• All conduct shall be in keeping with the highest Christian regard and respect for all persons. This is to include the direction of their leaders.
• All dress shall be in good taste and in accordance with the dress required by the school.
• All individuals are expected to join in all group activities.
• No profanity will be permitted.
• No outside (from home) toys will be permitted during CAPS. The purpose for this rule is so that no items will be lost, broken, fought over or distracting from the activities. The Church will not be responsible for lost, broken, or stolen items.

We (I) as parents (guardian) understand all parts of this agreement. If my child dis-regards this CODE OF CONDUCT then I understand and agree that the consequences are to be as follows:

• First offense – written warning will be sent home.
• Second offense – parent will be called.
Third offense – student and parent will have to meet with the pastor.

Electronic Parent (Guardian) signature

Date

Electronic Child’s signature

Date

PHOTO RELEASE PERMISSION

As a parent or guardian of this child, I hereby consent to the use of photographs / videotape for promotional and/or educational purposes (including publications, presentation or broadcast via newspaper, internet or other media sources). I do this with full knowledge and consent and waive all claims for compensation for use, or for damages.

- Select One -

Yes, I give consent for the First United Methodist Church of Lampasas to photo-graph my child for any church event.

No, I do not authorize the First United Methodist Church of Lampasas to photo-graph my child for any church event.

Electronic Parent (Guardian) signature

Date

Your form has been submitted. Thank You!