Elkin FUMC Weekday Programs Registration Form
Your child MUST be class age by August 31, 2018. Also, the 3 & 4 Year Old class MUST be potty trained. (No diapers or pull ups!)
Which class are you registering for? *
Full Name of Child: *
Your answer
Sex: *
Date of Birth: *
MM
/
DD
/
YYYY
Place of Birth:
Your answer
Name of Parents/Guardians: *
Your answer
Email Address *
Your answer
Address: *
Your answer
Home Phone:
Your answer
Cell Phone (Mother): *
Your answer
Cell Phone (Father) *
Your answer
Mother's Occupation & Phone Number: *
Your answer
Father's Occupation & Phone Number: *
Your answer
Local Church You Attend: *
Your answer
Emergency Contact Person: *
Your answer
Relation to Child: *
Your answer
Emergency Contact Person's Phone Number: *
Your answer
_____________ will pick up our child each day, unless a note is sent saying otherwise. *
Your answer
Please list any allergies/special needs or type "none:" *
Your answer
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