Yellow Springs United Methodist ChurchAfter School ProgramSpring 2007 |
My child_________________________________ has my permission to attend the Wednesday after school program at the Yellow Springs United Methodist Church.
__________________________________ Grade and teacher's name
Please check what applies:
____My child will walk from Mills Lawn to the church with an adult from the church program. I will pick up my child from the church at 4:45. (Please send a note to your child's teacher)
____I will bring my child to the church at 3:05, and pick him/her up at 4:45.
Emergency phone numbers where you and another person responsible for your child can be reached:
Name___________________________________ Phone___________________
Name___________________________________ Phone___________________
Are there any allergies or other medical conditions that we should be aware of?
______________________________________________________________________________________________
Parent Signature:______________________________ Date: ________________
The Cross and Flame is a registered trademark and the use is supervised by the General Council on Finance and administration of the United Methodist Church. Permission to use the Cross and Flame must be obtained from the General Council on Finance and Administration of The United Methodist Church-Legal Department, 1200 Davis St., Evanston IL 60201