First United Methodist Church of Wetumpka
Friday, November 17, 2017
Serving Christ in the River Region since 1819

Wednesday Registration

Child's Name (One per form, please) 
 
Child's Date of Birth        School Grade (2012-2013) 
 
Parent or Caregiver's Name(s) 
 
Home #      Cell# 
 
Work # 
 
Mailing Address 
 
Parent's email address 
 
Emergency Contact Name 
 
Relationship to Child    Telephone # 
 
Allergies or other medical conditions we should know about:
 
Other Comments:
 
I would like my child picked up from school and taken to church: 
 
He/she attends: