FaithWeaver Friends Fall 2017 Registration
Leesville United Methodist Church Beginning Sept 10 from 4:30 - 6:00pm
Parent/Guardian First Name *
Parent/Guardian Last Name *
Participant First Name *
Participant Last Name *
Gender *
Grade *
Please select the grade the student will be entering this fall.
Street Address or PO Box *
City *
State *
Zip *
Contact Phone Number 1 *
(xxx) xxx-xxxx
Contact Phone Number 2
(xxx) xxx-xxxx
Parent/Guardian Email *
Confirm Parent/Guardian Email *
Emergency Contact Name *
Emergency Contact Phone Number *
(xxx) xxx-xxxx
Child Pickup *
Other than you, who may pick up your child from FaithWeaver Friends?
Child's Photo Usage *
Do we have permission to use your child's photo?
Medical Information *
Include allergies. Put NA if there is none in which we need to be aware.
Would you like to receive more information about any upcoming children's programs offered by Leesville United Methodist Church? *
Please click Submit below to complete the registration.
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