Wednesday Church School Registration Form

Wednesday Church School Registration - School Year 2024 - 2025

* Indicates required field

Parent/GUARDIAN #1 Name *

First

Last

Parent/Guardian #1 Email *

Landline Phone Number *

Parent/Guardian #1 Cell Phone Number *

Parent/Guardian #2 Name *

First

Last

Parent/Guardian #2 Email *

Parent/Guardian #2 Cell Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Child/Youth #1 Name *

First

Last

CHILD/YOUTH #1 DATE OF BIRTH (MONTH/DAY/YEAR) *

child/youth #2 name *

First

Last

child/youth #2 date of birth (month/day/year) *

child/youth #3 Name *

First

Last

child/youth #3 date of birth (month/day/year) *

child/youth #4 Name *

First

Last

child/youth #4 date of birth *

Please list an alternate person as an emergency contact with their contact information in case we are unable to reach you. *

In case of an emergency, staff and volunteers of the UM Church of the Pins are authorized to take my child/children to the hospital for emergency care. *

Yes No

I give permission for my child/children to be photographed and/or videotaped to be used in church publications such as in worship. newsletters, website, and Facebook. *

Yes No

Please list any behavioral, dietary, allergies, or medical concerns we should be aware of that may affect your child's participation in church activities. *

Do you need help transporting your child to and/or from Wednesday Church School? *

Yes No

Are you able to help transport children to Wednesday Church School? *

Yes No

Submit