Ark Avenue Registration

Ark Avenue Registration (Birth-3 Years)

Please fill out the information completely. Fields marked with a * are required. Additional fields are available for families registering multiple children at once. If you have children who are preschool age or older, please register them through our Kids Under Construction registration page here. Thanks for helping provide with us information to help us serve you better!

Name (Child #1) *

First

Last

Child #1 Gender *

Child #1 Birthdate (MM/DD/YYYY) *

Child #2 Name *

First

Last

Child #2 Gender *

Child #2 Birthdate (MM/DD/YYYY) *

Child #3 Name *

First

Last

Child #3 Gender *

Child #3 Birthdate (MM/DD/YYYY) *

Parent/Guardian Name *

First

Last

Parent/Guardian Email *

Mailing Address *

Line 1

Line 2

City

State

Zip Code

Country

Parent/Guardian Phone 1 *

Parent/Guardian Phone 2 *

You may text my cell phone in case of emergency during services. (Please list this number as 'Phone 1' above) *

If applicable, please provide any of your children's medical conditions, allergies, custody restrictions, or other important information of which we should be aware. This information will be kept confidential. *

MEDIA RELEASE: I grant to Upland United Methodist Church and its children’s ministry, employees, and volunteers the right to take photographs, video, and/or electronic images of any member of my family in the children’s ministry environment. I authorize Upland United Methodist Church and its children’s ministry to copyright, use, and publish the photographs, video, and/or electronic images in print and/or electronically—with or without our names—for any lawful purpose to highlight and promote Upland United Methodist Church and its children’s ministry.

I agree to the above Media Release statement. *

Submit