Program Registration

                 Allergies: 

 

               Please enroll in:

 

                                             

                   Sunday school     VBS               

                                                                                                                                                                

                  Wed Night Jr/Sr High     Wed Night Youth-K thru 3 grade    Wed Night Youth 4-6 grade     

 

 

Child #2:          Birthdate:       Grade in School:

 

 

Child #3:          Birthdate:       Grade in School:

 

                Allergies Child #3:  

 I authorize People's United Methodist Church to utilze photographs of my child/children for purposes of the church only: YES   NO 

  

 

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: St. Marys Meriter UW