Mission and Vision
Meet the Team
Medina Weekday Preschool
Children + Family
I Want to Serve
Youth Campout and Water Wars Sign Up Sheet
This waiver needs to be filled out by a parent or guardian in order for you to attend.
Student First Name
Student Last Name
Parent/Guardian First Name
Parent/Guardian Last Name
Phone Number of Parent/Guardian
Emergency Contact First Name
Emergency Contact Last Name
Phone Number of Emergency Contact
We are going to be ordering pizza. For ordering purposes, can you tell us what type of pizza is your student's favorite?
Cheese with White Sauce
They ONLY eat (insert weird flavor below)
Weird pizza flavor (if you chose that section above)
Anything special we may need to know about your student? (Allergies. sleeping issues, medical conditions, etc)
I understand that while the leaders of Shield Student Ministry will do everything in their power to enforce social distancing, the responsibility to social distance is ultimately on my student(s).
I understand that, as with every other event at Medina UMC, my student may be photographed during this event and those photos may be used on social media or other media outlets.
I understand that I may be responsible to come collect my child at any time of night if their continued participation in the event presents a threat to themselves or others (including refusing to social distance, bullying, continued disrespect for leaders, etc.)