Eldridge UMC
Child's Name (required)
Parent's Name (required)
Email Address (required)
Phone Number (required)
Mobile Phone Number
Texting Available? YesNo
Your Street address
City
Child's Grade in the Fall (required) ---4-5 yrs oldK1st2nd3rd4th5th
Allergies (if any)
Emergency Contact name (required)
Emergency Contact Phone (required)
Emergency Contact Relationship (required)
Any additional information you would like to provide