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South Point United Methodist Weekday School
SUMMER PROGRAM (June and July) REGISTRATION FORM
 Preschool Summer Program (please circle)
2 & 3 year olds - Tuesday’s 4 & 5 year olds - Wednesday
 School Age Camp (please circle the desired camps)
Rising 1
st
Graders-Rising 2
nd
Graders (Tuesday) Rising 3
rd
Graders-Rising 5
th
Graders (Wednesday)
Science Camp (June) Arts & Craft Camp (July
 
) Science Camp (June) Arts & Craft Camp (July)
Child’s Name ____________________________________________________________ (First)(Middle)(Last) Name your child prefers to be called __________________________________________ Child’s Birth date _______________________________ Child’s Age _______________ Parent or Guardian’s Name _________________________________________________ Address ________________________________________________________________ Home Phone _________________________ Work/ Cell Phone ____________________ E-Mail Address __________________________________________________________ Parent or Guardian’s Name _________________________________________________ Address _________________________________________________________________ Home Phone _________________________ Work/ Cell Phone ____________________ E-Mail Address ___________________________________________________________ Siblings that live in the home (names and ages) __________________________________ Emergency Contact ________________________________________________________ Relationship to the child _____________________________________________________ Home Phone _________________________ Work/ Cell Phone _____________________ Please list any medical conditions that we should be aware of (allergies, asthma, diabetes,etc) ___________________________________________________________________ 
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