Club M. A. D.

Music - Art - Drama


The first day of Club MAD is Wednesday, September 6, 2017.  Club MAD buses will pick up at 3:00pm from the schools and end at 5:15 pm. If room is available, children may sign up throughout the semester. Children are placed in one of the choirs by grade in school. All Club MAD leaders and shepherds have completed Ministry Safe Training.

Register Here


Child's First Name*
Child's Last Name*
Parent Name(s) *
First Name
Middle
Last Name
Parent Name
First Name
Middle
Last Name
Address *
Address Line 1
Address Line 2
City
State/Prov.
Postal Code
Email*
Home Phone*
Parent phone at work*
Parent Alternate Phone
Child's Birthday*
Gender *
T-Shirt Size*
grade child will enter in Fall 2017*
School Child Attends
Height of child (in inches)
Does your child participate in school: Please select all that apply:
Does your child play a musical instrument?
If so What?
Note: We will have as many as 5 parties throughout the year. Please number in order of preference the parties for which you would like to assist:
I can assist with:
Would you consider being a choir mom or dad?
Annual tuition per child is $30.00 (includes t-shirt, supplies, etc.) Maximum tuition per family is $45.00. If scholarship assistance is needed, please contact Kim Schultz at 817-326-4242. Please note which tuition applies to you.*
Who will pick up your child? If multiple people will be picking up your child or children, we must have a list of their names and phone numbers or we will not release your chilldren to them. We will ask to see driver's license if we do not know them. Please provide names and phone numbers here.
Allergy Information
explain allergic reaction
Alternate Contact Name *
First Name
Middle
Last Name
Alternate Contact Phone*
Primary Physician Name *
First Name
Middle
Last Name
Primary Physician Phone*
are shot records up to date?*
There will be times when we take the Club M.A.D. children on a "field trip". I give Acton UMC permission to take my child(ren) on the field trips.*
I give Acton UMC permission to transport my child(ren) in our church bus after school or for "field trips". I understand I will be notified in advance any time a "field trip" is planned".*
Bus will pick up from (parents pick up children at 5:15pm in the CLC) *Capacity for our buses is 68 children after that is reached parents will be asked to provide transportation to the church.
Statement of Treatment / Medical and photo release
In case or needed emergency medical treatment, I hereby give permission to the physician selected by Acton United Methodist Church to secure treatment for my child, as named above. I further authorize Lake Granbury Hospital to release pertinent information to Acton staff for the purpose of parental/guardian notification. I recognize the natural risks of injury or disability inherent in my child's participation in Club M.A.D. at Acton UMC and hereby assume the risk of injury that could result from these activities. I release Acton United Methodist Church, their staff, and volunteers from liability for injury to my child from participation in these and other programs. I give permission for my child's photo(s) to be utilized at the discretion of Acton United Methodist Church staff, which includes the Acton United Methodist Church website. I undertand that no names will be used with the photographs. Please type parent/guardian full legal name to serve as an electronic signature*

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