Summer Reading Program | Peace United Methodist Church, Fredericksburg, Virginia

Please complete this registration for your child to participate in the Peace UMC Summer Reading Program

If you have more than one child, please complete the form for each child

Child's Name (Required)

Child's Age (Required)

Child's Current Grade in School (Required)

Parent/Guardian Name (Required)

Your Phone Number (Required)

Email Address (Required)

Home Address (Required)

Any Allergies of Medical Issues (please describe):

Emergency Contact (if different from parent/guardian)

In the event of an emergency, who do we contact? Phone number?

Authorized Pickup Person(s): (Required)

I give permission for my child to participate in the Summer Reading Program at Peace UMC. (Required)

By choosing yes, you are acknowledging that you understand the Summer Reading Program and are authorizing our child to participate.

Solve 5 + 7 = ?

Peace United Methodist Church, Fredericksburg, Virginia