Upland United Methodist Church
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Upland UMC
Kiddie Kampus Registration Application
Please fill out the information completely. Fields marked with a
*
are required.
For which session are you applying?
*
Session I (8:30 - 11:00 AM; must be 3 years old AND potty trained by 8/1/17)
Session II (12:00 - 2:30 PM; must be 4 years old AND potty trained by 8/1/17)
Child's Name
*
First
Last
Birthdate (MM/DD/YYYY)
*
Place of Birth
*
Gender
*
Male
Female
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Email Address
*
Mother/Guardian Name
*
First
Last
Mother/Guardian Occupation
*
Mother/Guardian Phone
*
Mother/Guardian Work Phone
*
Mother/Guardian Address (If different than child's)
*
Line 1
Line 2
City
State
Zip Code
Country
Father/Guardian Name
*
First
Last
Father/Guardian Phone
*
Father/Guardian Occupation
*
Father/Guardian Work Phone
*
Father/Guardian Address (If different than child's)
*
Line 1
Line 2
City
State
Zip Code
Country
Is child adopted?
*
Yes
No
If adopted, at what age was adoption?
*
If adopted, is child aware of adoption?
*
Yes
No
Please describe any custody arrangements, if applicable, regarding the child’s visitation with a parent/guardian
*
Submit
Click here
to make online application fee payment
after
clicking "Submit" on above form
($30
before
June 1; $60 if
after
June 1
)