West End Presbyterian Church
275 Knox Lane
West End, NC 27376
(910) 673-4341
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DEAR PARENT/GUARDIAN
:
Please fill out ALL the fields below. If your child DOES NOT have any allergy/medical concerns enter an "NA" in the appropriate field. Thank you!
Children's Sabbath Registration | Jan. 23, 2016
*
Indicates required field
Parent/Guardian Name
*
First
Last
Email
*
Best Phone #
*
Alternate Phone # (opt'l)
*
1st CHILD'S NAME
*
First
Last
Select One - Age/Grade Completed
*
Age 3
Age 4
Age 5
Kindergarten
Gr 1
Gr 2
Gr 3
Gr 4
Gr 5
Child #1 Allergy/Medical Concerns
*
Please enter "NA" if you have no medical/allergy concerns.
2nd CHILD'S NAME
*
First
Last
Select One - Age/Grade Completed
*
Age 3
Age 4
Age 5
Kindergarten
Gr 1
Gr 2
Gr 3
Gr 4
Gr 5
Child #2 - Allergy/Medical Concerns
*
Please enter "NA" if you have no medical/allergy concerns.
3rd CHILD'S NAME
*
First
Last
Select One - Age/Grade Completed
*
Age 3
Age 4
Age 5
Kindergarten
Gr 1
Gr 2
Gr 3
Gr 4
Gr 5
Child #3 - Allergy/Medical Concerns
*
Please enter "NA" if you have no medical/allergy concerns.
Submit