PVUMC Children's Registration Form

Birth-5th Grade Registration Form

Please fill out one form for each child
Child's Name

FirstMiddleLast
Birth Date

MonthDayYear
Gender*
Current Grade

InfantsToddlers and 2's3 and 4 year old classKindergarten1st grade2nd grade3rd grade4th grade5th grade
Address

Home Address

Address Line 2

CityState / Province

Zip CodeCountry
Parent/Guardian's Name

First NameLast Name
Parent/Guardian's Name

First NameLast Name
Parent E-mail
Preferred Number

Area CodePhone Number
Work Number

Area CodePhone Number
Allergies or concerns
Areas child is involved in

8:15 Children's Church9:45 Sunday School11:15 Children's ChurchWednesday NightsCan Do Kids - Thursday nights
Should be Empty:

Birth-5th Grade Registration Form