CHILDCARE REGISTRATION FOR A SPECIAL EVENT

Thank you for allowing us to care for your child! At Clemmons UMC we take childcare seriously: we want to provide the safest and most enriching experience possible for your child. If you have any questions, please email our children's minister Rev. Sara Smith or read more about our children's ministry.

Parent

First Name

Last Name

Name of Event Attending

Children Names/Ages

Allergies

Yes

No

If yes, list allergies here:

Parent Phone

(###)

###

####

Email Address

Emergency Contact Name

First Name

Last Name

Emergency Contact Phone

(###)

###

####

Relationship to child(ren)

Liability Waiver

Signature

Questions or Comments

Our Office

3700 Clemmons Rd
Clemmons NC 27012
USA

CHILDCARE REGISTRATION FOR A SPECIAL EVENT

Our Office

Clemmons UMC is a Stephen Ministry Congregation.