News and Events

Click on event brochure below to find out about this exciting summer program!

Live free summer reading program brochure 2015.pdf

LIVE fREE Registration Information

Student Information

Student’s Name:
Date of birth:
Grade Entering:
ZIP Code:

Parent/Guardian Information

Parent/Guardian Name:
Relationship to Student:

Emergency Contact

Emergency Contact Name:
Emergency Contact Phone Number:
Relationship to Student:
Does this person have your permission to pick up student for any reason? (circle)               YES             NO

Spouse/other parent Information if different from emergency contact

Relationship to Student
Does this person have your permission to pick up student for any reason? (circle)              YES              NO

Please List any and all allergies or medical conditions:



I verify that the information provided on this form is valid and true.  I release adult supervisors and Prospect United Methodist Church from responsibility for accidents during church-sponsored activities.  In case of emergency, I, the parent/legal guardian of the registered minor, give permission to the adult supervisors to secure proper treatment for the health and comfort of my child until I can be reached.
Signature of applicant:
Media Release: permission for Capital Area North District to use pictures:  (Initials)
Registration forms can be returned to Prospect UMC by mail or drop off Mon, Weds. Or Fri 9 am – 1 pm

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