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Children's Ministries Registration (2011-2012)

Every fall we ask families to register ALL of their children to ensure we have the most accurate family contact and allergy/special needs information for each of the kids attending Waumba Land and UpStreet. Thank you for completing this info!
Infant - 5th Grade

Parent/Guardian Information

1st Parent/Guardian

Name: *

Relationship to Child: *

Main Phone: *

Cell Phone

Home Phone

Work Phone

Secondary Phone:

Cell Phone

Home Phone

Work Phone

2nd Parent/Guardian

Name:

Relationship to Child:

Main Phone:

Cell Phone

Home Phone

Work Phone

Secondary Phone:

Cell Phone

Home Phone

Work Phone

Which parent/guardian contact information should we use in case of emergency: *

Parent/Guardian 1

Parent/Guardian 2

Which email address would you like to receive updates on your child's classroom:

Home Information

Address: *

City: *

State: *

Zip: *

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Math question: * 6 + 1 =

Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.

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