After-School Program — Winder First

2023-2024
k-5 THROUGH 5TH GRADE
After School Program

We are super excited about our upcoming 2023-24 After-School Program. We offer pick-up at Holsenback, County Line, Statham, Winder. If you are ready to register, please fill out the registration form below and an invoice for registration will be sent to you. Please contact Donna Sue Gallups at 770-586-5417 ext. 115 or fill out the contact form below for more information.

Registration Form

Child's Full Name

First Name

Last Name

Grade (2023-2024 School Year)

School

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

We will use this for weekly communication and/or online invoicing only.

Father's Name

First Name

Last Name

Father's Phone Number

(###)

###

####

Mother's Name

First Name

Last Name

Mother's Phone Number

(###)

###

####

Child Lives With

Father

Mother

Both Parents

Other (Guardian, Grandparent, etc)

Emergency Contact #1

Please list someone to call in case of an emergency if the parent(s) cannot be reached. This person may also pick up child.

First Name

Last Name

Emergency Contact #1 Phone

(###)

###

####

Emergency Contact #2

First Name

Last Name

Emergency Contact #2 Phone

(###)

###

####

Please list any other people that have permission to pick up your child:

Please include Relationship and Phone Number for each person. ID will be checked.

Special Instructions: (Allergies, Diet, Medical, Behavioral, Extraordinary Circumstances)

Please be specific. The more we know, the better we can serve your child.

Child's Physician

Physician Phone Number

(###)

###

####

Medical Insurance Policy and Number

Please Choose One

I give permission for photographs of my child to be used by the After School Program on bulletin boards, in the local newspaper and on the church website.

I DO NOT want photographs of my child used by The After School Program.

Signature

My signature below acknowledges that I have been provided with a copy of the Winder First United Methodist After School Program Parent Handbook, have read, understand, and agree to abide by all policies and procedures therein. Should my child need medical attention, I understand that every effort will be made to contact me. If I cannot be reached, I authorize permission to seek immediate medical attention for my child. In placing my child in this program being offered by the FUMC Family Life Center I realize there comes a certain degree of risk of possible injury or illness (including but not limited to COVID-19) that might occur from such programming. Therefore, it is understood by me that such a degree of risk exists and that I agree to hold Winder First United Methodist Church and the Pasley Family Life Center harmless from any claims resulting from injury in the program provided.

Date

YYYY

Printable registration form

Contact Us

We would love to answer any questions you have about our incredible after school program. Please fill this form with any questions you have and we will be in touch soon!

Name

First Name

Last Name

Subject

Message

2023-2024 k-5 THROUGH 5TH GRADEAfter School Program

Contact Us

2023-2024
k-5 THROUGH 5TH GRADE
After School Program