Enrollment Form

Child's Name

Nickname

Child's age

Grade in Fall

Date of Birth

Parent/Guardian Names

Email Address

Cell Phone #

Other Phone

Address

City

State

Zip

Do you attend Wilson United Methodist Church? Do you attend Wilson United Methodist Church?YesNo

Emergency Contact

Emergency Contact Phone Number

Other Adult that can pick up your child

Phone #

Second Authorized adult that can pick up child

Phone #

Allergies, Restrictions or Special Instructions:

Check here if you're available to volunteer for 1 or more days Check here if you're available to volunteer for 1 or more daysYesNo

Additional Child

Nickname

Age

Grade in Fall

Date of Birth

Additional Child

Nickname

Age

Grade in Fall

Date of Birth

Anything else our team should know about your child?