AWOMMA 2017 Registration Form
AWOMMA (A Week of Making Music and Art) will be held at FUMC Stephenville from Sunday, July 30-Wednesday, August 2.
Email address *
Child's Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Last grade completed *
Home phone (or cell) *
Your answer
Address *
Your answer
City *
Your answer
State *
Your answer
ZIP code *
Your answer
Mother's Name *
Your answer
Mother's Phone *
Your answer
Father's Name *
Your answer
Father's Phone *
Your answer
Other Emergency Contact
Your answer
Other Emergency Contact Phone
Your answer
Name of other person who will pick up this child
Your answer
Phone Number of pickup person
Your answer
Allergies/Special Needs (food, medicine, etc.) *
Your answer
Preferred Physician *
Your answer
Preferred Physician Phone *
Your answer
Confirmation *
Required
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