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Faith United Methodist Church
507-794-6565
                                                                              JAM Registration 2018-2019


Parent Name(s):_________________________________________________________________________

Children’s Name(s) & Age(s):

Name:_________________________Age:_____ Grade:______Allergies/Meds:________________________

Name;_________________________Age:_____ Grade:______Allergies/Meds:________________________

Name;_________________________Age:_____ Grade:______Allergies/Meds:________________________

Name;_________________________Age:_____ Grade:______Allergies/Meds:________________________


Street Address:____________________________City:________________________State:____Zip:____________

Home Phone:( )______________Cell Phone: ( )___________________Other: ( )______________

Email Address:__________________________________________________________________________

 If we are unable to reach the person listed above, who should we contact?
Name:______________________________Phone:_____________________Relationship:______________

May we have permission to photograph our child? Yes _______ No_________

I give permission for________________________________ to participate in JAM at FaithUMC.

Parent Signature:______________________________________________________


Faith United Methodist Church Questions: Contact- Gina Nienhaus
321 1st Ave South Sleepy Eye, MN. 507-794-6923 or 507-920-8976
507-794-6565 email- faithumcyouth@hotmail.com


I, the undersigned parent/guardian, do hereby grant permission for my son/daughter, named above, to attend the JAM /youth event. In order that my child may receive the proper medical treatment in the event that he/she may sustain injury or illness during JAM, I hereby authorize the JAM staff to obtain or provide medical treatment for my child for such injury or illness during the JAM, and I hereby hold the JAM staff and sponsoring organization(s), as well as its representatives, harmless in the exercise of this authority. I

I further understand that there is always a possibility that my child may sustain physical illness or injury while at the JAM. If this occurs, I hereby authorize the JAM staff and representatives to refer my child to a medical treatment center. I further acknowledge and understand that I will be responsible for any medical bills that may be incurred on behalf of my son/daughter for physical illness or injury that he/she may sustain during the JAM. 

Understanding that there is always a possibility that my child may sustain physical illness or injury, I acknowledge and understand that my child is assuming the risk of such physical illness or injury by his/her participation, and I further release the sponsoring organization and its representatives from any claims for personal illness or injury that my child may sustain during JAM. I further acknowledge and under-stand that my child will be responsible for his/her failure to abide by the rules and regulations of the JAM. 

Name of Parent/Guardian _______________________________________________________ 

Date _______________ Signature of Parent/Guardian ________________________________