Parent Name

First Name

Last Name

Name, Birthdate, Age & Grade of ALL Children participating in WOW Kids

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Cell Phone

(###)

###

####

Parent/Guardian Information (List 2) Include Name, Relationship, Phone # and Address

Who has custody of the child?

Father

Mother

Both

Other

Are you currently affiliated with a church?

Yes

Keymar Wesleyan has permission to post photos of my children on church social media.

YES

Please list any allergies or dietary restrictions for your child(ren).

I authorize the WOW Kids staff to obtain emergency medical care, which could include the following procedures: minor first aid, CPR, calling 911, and/or transportation by ambulance to hospital for my child.

Yes

Pick Up List 2025-2026

Please list the names/phone #'s/relationship of all those who may be picking up your child with your permission. For safety purposes, if a person who is not on the list will be coming to pick up your child you will need to inform us. The party picking up your child will need his/her driver's license in order to have the child released to their custody.

‘25-’26 Registration