PVUMC Children's Registration Form

Birth-5th Grade Registration Form

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

First Middle Last
Birth Date *

Month Day Year
Gender *
Current Grade *

Infants Toddlers and 2's 3 and 4 year old class Kindergarten 1st grade 2nd grade 3rd grade 4th grade 5th grade
Address *

Home Address

Address Line 2

City State / Province

Zip Code Country
Parent/Guardian's Name *

First Name Last Name
Parent/Guardian's Name

First Name Last Name
Parent E-mail *
Preferred Number *

Area Code Phone Number
Work Number

Area Code Phone Number
Allergies or concerns *
Which service would you prefer to attend? *

8:15 Traditional 9:45 Contemporary 11:15 Traditional 6:30 Thursday night
Areas you are interested in serving: *

Nursery Sunday School Check-ins, temp checks Children's Ministry Team Future Programs None of the above
Should be Empty:

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Birth-5th Grade Registration Form