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MUMC Children and Youth Program sign up
The Red Brick Church up the hill...
Email address *
Child or Youth's Full name *
Your answer
Child or Youth Birthdate *
MM
/
DD
/
YYYY
Parent or Guardian's name *
Your answer
Phone number (best # to reach you) *
Your answer
Relationship to children *
Your answer
Mailing Address
Your answer
Number of people living in the household
Your answer
How did you hear about us? *
In which programs are you interested? *
Required
May your child or youth appear in media such as website, Facebook, and flyers? *
Allergies, medical, special needs or other concerns *
Your answer
Emergency contact name, best phone # and relationship to child or youth *
Your answer
If you child needs transportation, provide details below:
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