WNL! 2019 Winter Registration for Children and Youth
Winter 2018/2019 WNL Registration for Children and Youth

Winter Semester: Classes will begin January 16 through April 10, 2019; except March 20 for Spring Break

What is the cost per semester? 2, 3, 4 year old: $40 per child
K-High School: $50 per child with a family maximum of $125

Free Nursery for children under 2 years old, for WNL Volunteers and Adult Class participants

Payment is due on the first night of WNL (January 16)

Please complete a separate registration form for each individual you wish to register

Child's Name *
Your answer
Date of Birth (mm/dd/yyyy) *
Your answer
Grade (as of Fall 2018/2019) *
Parent 1 Cell (xxx-xxx-xxxx) *
Your answer
Parent 2 Cell (xxx-xxx-xxxx)
Your answer
Parents *
Your answer
Allergies? Carry an EPI pen?
Your answer
Health conditions or special needs/restrictions?
Your answer
Street Address *
Your answer
City/Zip *
Your answer
Parent 1 Email *
Your answer
Parent 2 Email
Your answer
Emergency contact other than parent *
Your answer
Emergency contact's number (xxx-xxx-xxxx) *
Your answer
Please list people who may pick up your child *
Your answer
Physician's name *
Your answer
Physician's number (xxx-xxx-xxxx) *
Your answer
Church Affiliation *
Authorization for treatment of a minor: My child/children listed above have my permission to participate in all the activities of the WNL ministry at First Presbyterian Church. I understand that in the event medical intervention is needed, every attempt will be made to contact immediately the person listed on this form. In the event I cannot be reached or the alternate contact person cannot be reached in an emergency I hereby give my permission to the physician or dentist selected by the activity leader (acting as agent/representative for First Presbyterian Church) to hospitalize, to secure medical treatment and/or emergency medical transport for my child as deemed necessary. *
Photo Release: I give permission for my child’s photograph to be taken during WNL events and used for internal publicity purposes and FPC church publications (including our weekly email newsletter and the church website). *
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