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Wonderful Wednesday Kids Registration
2021-22 School year
St. Luke UMC
1608 E. Pine St.
Goldsboro, NC 27530
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* Indicates required question
NAMES/AGES/BIRTHDAYS (please list each child's name, age as of Sep 8th, and date of birth below)
*
Your answer
Emergency contact (Name/Relation to child)
*
Your answer
Phone Number
*
Your answer
Email
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Your answer
Best way to contact you?
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Phone
Email
Mail
Other:
Dietary restrictions
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None
Vegetarian
Vegan
Gluten-free
Other:
Are there any medical conditions that may interfere with WWK?
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Yes
No
If "yes" above, please elaborate so we can serve your family in the best way possible.
Your answer
List persons and their relationship to your child/children who will regularly pick up your child/children on Wednesday nights if not the parent(s)
Your answer
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