Friendship United Methodist Church
CHRISTIAN FINE ARTS CAMP 2010
AUGUST 2 - 6
9:30 a.m. – 12:00 p.m.
ATTENDANCE REGISTRATION/EMERGENCY CARE FORM
Preschool Children (Must be age 3 by August 3, 2009 and potty trained)
through Graduated 5thGrade.
Registration fee is $15.00 per child, Make checks payable to FUMC (memo CFAC). Mail check and completed form to FUMC 3527 Gallows Road Falls Church, VA 22042.
Additional forms are also available on our website www.friendshipumc-va.org
We plan to communicate primarily by email.
CFAC Celebration Sunday, August 8
PLEASE PRINT OR TYPE CLEARLY (One form per child):
Child's Name_______________________________________________
Date of Birth _____________________________
Preschool age ______ or Grade Completed as of June 2010 _________________
Church Attended___________________________________
Day Phone ____________________ Evening Phone ________________________
Cell phone__________________________
E-Mail Address _________________________________________________________
(please print clearly)
Home Address _______________________________________________
City __________________Zip _________________
Parent(s) or Legal Guardian’s Name(s)
_______________________________________________________
Is/Are Parent(s)/Guardian(s) able to Volunteer? (Please circle) YES NO
Child’s Primary Physician ____________________________________________
Physician Phone _________________________
Health Insurance Plan Name and ID#
__________________________________________________________________________
Is our child under physician’s care on a continuing basis? (Please circle) YES NO
Does your child take medication on a daily basis? (Please circle) YES NO
If yes, please specify _________________________________________
Does your child have allergies**? (Please circle) YES NO
If yes, please specify ________________________________________________
**If your child has food allergies, please PROVIDE snacks for your child.
During CFAC week, photos/video recordings will be taken for use by FUMC in promotion of the Christian Fine Arts Camp and children’s Ministries on our church website, bulletin boards and other church publications. If one chooses not to have their photos taken, please fill out a FUMC Photo Opt Out form available in the church office.
A complete discloser of FUMC’s photo policy is available at the FUMC website
and church office.__________
In an emergency, Friendship United Methodist Church (FUMC) has my permission to call my child’s physician (or another physician when my child’s physician or I cannot be contacted). FUMC has my permission in an emergency, when I (or my physician) cannot be contacted, to take my child to the Fairfax Hospital Emergency Department, and its medical staff has my authorization to provide treatment, which a physician deems necessary for the well being of my child. By law a parent or legal guardian cannot consent in advance to any and all manner of emergency care. It is understood in most cases, other than the need for immediate emergency treatment, the attending physician may defer treatment pending the parent’s or guardian’s expressed permission to administer such treatment.
Parent’s or Guardian’s Signature: _________________________________
Today’s Date:_______________________________________
*Scholarships available. Please contact the church office for information.