Cdo%20registration%20form%202012
1
EPWORTH CHILDREN’S DAY OUT REGISTRATION FORM) Entrance Date____________ For Office Use Only: Preferred day ____________ Regis.Fee____________ 2nd choice ____________ Paid:_____ By________ Date:________ CHILD’S NAME_________________________________________________________ (Last) (First) (Middle) (Name for Nametag) Address________________________________________________________________ (Street) (City) (State) (Zipcode) Phone___________________________ Child’s Birthdate______________ Mother’s Name____________________________________ Address (if different)______________________Phone (if different)_____________ Employer Name___________________________Phone________________________ Address________________________________________________________________ (Street) (City) (State) (Zipcode) Father’s Name ___________________________________________________ (Address (if different)_____________________Phone (if different)_____________ Employer Name____________________________________Phone __________________ Address________________________________________________________________ (Street) (City) (State) (Zipcode) Parent email address to be used for CDO communications only____________________ Please give any information regarding the child’s physical, emotional, or social health which might be of value to the staff.________________________________ ________________________________________________________________________ Registration fee of $30 per child or $45 per family must accompany this form. Registration fee is not refundable. Make checks payable to Epworth United Methodist Church, Please note “CDO” in memo line.
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Transcript of Cdo%20registration%20form%202012
EPWORTH CHILDREN’S DAY OUT REGISTRATION FORM) Entrance Date____________ For Office Use Only: Preferred day ____________ Regis.Fee____________ 2nd choice ____________ Paid:_____ By________ Date:________ CHILD’S NAME_________________________________________________________ (Last) (First) (Middle) (Name for Nametag)
Address________________________________________________________________ (Street) (City) (State) (Zipcode) Phone___________________________ Child’s Birthdate______________
Mother’s Name____________________________________ Address (if different)______________________Phone (if different)_____________ Employer Name___________________________Phone________________________ Address________________________________________________________________ (Street) (City) (State) (Zipcode)
Father’s Name ___________________________________________________ (Address (if different)_____________________Phone (if different)_____________ Employer Name____________________________________Phone __________________ Address________________________________________________________________ (Street) (City) (State) (Zipcode)
Parent email address to be used for CDO communications only____________________ Please give any information regarding the child’s physical, emotional, or social health which might be of value to the staff.________________________________ ________________________________________________________________________ Registration fee of $30 per child or $45 per family must accompany this form. Registration fee is not refundable. Make checks payable to Epworth United Methodist Church, Please note “CDO” in memo line.
