First United Methodist Church, Hillsboro, Texas » Online Registration

Online Registration

Wesley Academy Parents Day Out Registration Form

First United Methodist Church

Post Office Box 673, Hillsboro, Texas 76645

Student Information:

Full Name of Student(required)
Name Child is Called(required)
Birthday
Sex(required)
Right or Left Handed?(required)

Parent Information:

Father's Full Name
Father's Address
Father's Home Phone#
Father's Cell Phone #
Father's work Phone #
Mother's Full Name
Mother's Address
Mother's Home Phone #
Mother's Cell Phone #
Mother's Work Phone #
Email

General Information:

How did you find out about our program?
Religious Affiliation

Emergency Contact Information:

Please enter Three persons who would assume responsibility for your child in case of an emergency, if the school is unable to contact parents.
Name
Relation
Phone #
Name
Relation
Phone #
Name
Relation
Phone #
Physician's Name
Physician's Phone #

Spam Protection Question:

The question below is on this form to prevent web spybots from submitting this form without human participation. Thank you for your cooperation.
Ten minus five equals

cforms contact form by delicious:days