Children & Student  Registration          Dixboro United Methodist Church 

FALL 2023: Children & Student Program Registration Dixboro United Methodist Church. 

Required ANNUALLY for participation in children and student activities.

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Child/Student Legal Name
Child/Student Preferred Name
Child/Student Birth Gender (optional)
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CHILD/STUDENT Preferred Gender Pronouns (optional)
Child/Student Birthdate
MM
/
DD
/
YYYY
Child/Student Address
Child/Student School District and School name
Child/Student's Grade Fall 2023 and year of high school graduation
Child/Student Cell phone  (optional)
Child/Student email (optional)
First Parent or Guardian Name *
First Parent or Guardian Address (if different than child's - reply na) *
First Parent or Guardian Cell Phone *
First Parent or Guardian Email Address *
Second Parent or Guardian Name *
Second Parent or Guardian Address (if different than child's  reply NA) *
Second Parent or Guardian Cell Phone
Second Parent or Guardian Email Address *
Alternate Contact Name, Relationship, and Phone
Parent/guardian Preferred means of communication
Email to both parent/guardians
Email to parent/guardian #1
text to both parent/guardians
text to parent/guardian #1
phone call to both
phone call to #1
Parent preferred non-emergency means of communication
Students preferred means of communication
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