Sunday School at MUMC

Student's First Name

Student's Last Name

Student's nickname: please enter the name your child prefers to be called

Student's Birthdate (dd/mm/yyyy)

Student's Grade (entering) Child must be at least 4 yrs. old.

Parent/ Guardian Name Filling Out this Form

Mother's Name: please enter full name

Father's Name: please enter full name

Emergency Contact Phone #

Home Phone #

E-mail address

Please indicate what to do in case of emergency.

Student Medical Information. Please include allergies and name of preferred Hospital if applicable.

Please explain anything else we should know. Information is kept confidential and will only be used to better serve your child.

Are you a member of MUMC?

Yes

No

Would you like information on becoming a member?

Yes

No

Not at this time

Please indicate your release for photos to be posted.

Please indicate if your child's name can be printed with photo.

Yes

No

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