Grace United Methodist Church
Thursday, July 18, 2019

Wednesdays Kids

Fall 2017 Registration Form


The Wednesday evening children’s program is for preschoolers (potty-trained) thru 5th graders. Two separate 5- week sessions will take place this fall. Each evening runs 5:30-7:30. No fee is required, however an offering will take place each week to help cover program costs. Please complete this form and turn into the church office (420 California Dr. Coal Center, PA 15423) or in the Sunday offering plate. Questions?? Email or call the church at 724-330-5350. Full details online at 

General Information
Family Last Name: 
My child(ren) will attend Session 1: Emojis  September 27 - November 1
My child(ren) will attend 
Session 2: Topic to be determined November 8 - December 6th
My child(ren) will attend both Session 1 and Session 2 (listed above). 
Child's Name:      School:      Grade:      Birthday: 
Child's Name:      School:      Grade:      Birthday: 
Child's Name:      School:      Grade:      Birthday: 
Child's Name:      School:      Grade:      Birthday: 
Child's Name:      School:      Grade:      Birthday: 
Personal Information
Parent(s) / Guardian(s): 
Any other adults eligible for pickup: 
Phone Numbers (best contact(s)):   
E-mail address(es):
Allergies (Please be as specific as possible):
Anything else we need to know:
Media Permission:  I, , parent / guardian of  give permission for my child(ren) to be photographed, videotaped, and/or interviewed by representatives from the media or Grace United Methodist Church for the purpose of publicizing ministries or special events, including posting on websites affiliated with Grace United Methodist Church.  I authorize the use and reproduction by Grace United Methodist Church or anyone authorized by Grace United Methodist Church of any and all photographs, video, or sound recordings taken of my child(ren) without compensation to me / my child.  All of these photographs, videos, or sound recordings shall be the property of Grace United Methodist Church.
Signed:           Date: 
In Case of Emergency: In the event of illness or accident, if I cannot be reached, I authorize the church or its agents to consent to diagnosis, examination, treatment, transport to medical center / hospital, or hospital care for my child which is deemed necessary by and is rendered under the supervision of a physician.  I release the church and its agents from responsibility in the case of an accident or illness in connection with any church activities.
Signed:           Date: