People's United Methodist Church
Wednesday, February 22, 2012
Where Hearts are Heard

Program Registration

Child #1:          

Birthdate:       Grade in School:

Allergies: 
 
               Please enroll in:
   Sunday School   
   VBS              
  Wednesday Night Jr/Sr High
  Wednesday Night Youth: K-3grade
  Wednesday Night youth: 4-6 grade                                             
 
 

Child #2:

Birthdate: Grade in School:

Allergies:
 
 
Please enroll in:
Sunday School
VBS
Wednesday Night Jr/Sr High
Wednesday Night Youth: K-3grade
Wednesday Night youth: 4-6 grade
   
 
 
 

Child #3:

Birthdate: Grade in School:

Allergies:
 
Please enroll in:
Sunday School
VBS
Wednesday Night Jr/Sr High
Wednesday Night Youth: K-3grade
Wednesday Night youth: 4-6 grade
    
 
 I authorize People's United Methodist Church to utilze photographs of my child/children for purposes of the church only: YES   NO 
  
  Contact Information
 
Parent/Guardian's Name:            Email:                                        
 
Address:     City, State, ZIP:    
 
Home Phone:   Work Phone:   Cell Phone: 
 
  
Emergency contact name: 
     
  Relationship:      Home phone:
 
Primary Physician:      Phone:  
    
 Preferred Hospital:
 
 
I authorize People's UMC to seek out emergency medical care in the event that I, nor an emergency contact can not be contacted immediately. YES  
 
 
 Parent Participation 
 
Parent/Guardian's Name:      Please indicate below the area of assistance you prefer to help:
 
Preschool:                                   Elementary:                                 Assistants:                         
Bible Study Leader                 Bible Study Leader                  Preschool                   
Craft Leader                           Craft Leader                            Craft Assistants          
Play Time Leader                   Game Leader                           Snack Assistant  
 
Other:
 Snack Coordinator      
Treasure Hunt Leader
Treasure Hunt Assistant