PDO One Registration Form - Wesley United Methodist Church

Name of Child (First & Last)*

Child's Date of Birth*

Child's Gender*

Parent/Guardian Name (First & Last)*

Parent/Guardian Address (City & Zip)*

Parent Contact Number (Including area code)*

Email*

Child's Emergency Contact (Full name, phone number, and relationship)*

List of Diagnosed Allergies*

I understand the registration fee of $50 is due at time of registration and is non-refundable.*

I understand my child must be 1 on or before September 1, 2024 to attend Parents Day Out 1 at Wesley United Methodist Church Greenville.*

I understand my child must be walking and self-feeding to attend Parents Day Out 1 (Nursery) at Wesley United Methodist Church Greenville.*

Class Days of the Week? Select Only One.

Supply Fee to be paid 2x per year (Aug & Jan). Select Only One.

Parents Day Out 1 Registration 2024-2025 (1 by 09/01/2024)