2019 Annual Conference RECESS Registration

The Contact information above MUST be the child's parent or guardian.

Our Recess Program is operated on a first come, first serve basis. We have a limited amount of space available for the program (12 children).
The cost of Recess is $25 per child.

1 - Child Personal Information
Name of Parent/Guardian
First Name
Last Name
Email
Name of child(ren)
*First Name *Last Name
2 - Parent/Guardian Information
*Address

This is a required field

*City/State/Zip

This is a required field

*Phone

This is a required field.
What phone number may we use to call you with questions before Annual Conference?

3 - Church and District Information
*Lay Church Membership / Clergy Appointment

A selection is required.

*District

A selection is required

4 - Registration Information
*RECESS is a program for Children in 1st through 5th Grade during Annual Conference

The cost of RECESS is $25

Register my Child for Recess - You MUST select the required days below ($25)
*Select the days you require Recess

If you are registering more than 1 child - You must select a separate answer for each child. The cost of Recess is $25 per child.

Thursday
Friday
Saturday
*Child Age

A selection is required. Identify the age of the child as of June 5, 2019

*Child Grade

A selection is required. Identify the grade the child attended during the 2018-2019 school year.
Please note that this program is for children who just finished grade 1 through 6.

*Does the child have any restricted activities?

This field is required. If none please enter "none"

Favorite Movie
Favorite Sport
Favorite Snack
Favorite Board Game
Anything else important to know about your child?
5 - Medical Information
*Emergency Contact at Annual Conference - Name

This is a required entry. Please enter the full name of your emergency contact at Annual Conference.
This is somebody who will be at Grove City during the same time as you.

*Emergency Contact at Annual Conference - Cell Phone Number

This is a required entry. Please enter the cell phone number of your emergency contact at Annual Conference.
This is somebody who will be at Grove City during the same time as you.

*Emergency Contact at Home - Name

This is a required entry. Please enter the full name of your emergency contact at home.
This is somebody who will NOT be at Grove City during the same time as you.

*Emergency Contact at Home - Phone

This is a required entry. Please enter the home and/or cell phone numbers of your emergency contact at home.
This is somebody who will NOT be at Grove City during the same time as you.

*Allergies

This is a required entry. Please enter any allergies in the box below. If none, enter "none"

*Medical Conditions

This is a required selection. Select all that apply. If none apply to you, please select "none of these conditions apply to me"

Insulin Dependent Diabetes
Heart Disease
High Blood Pressure
Seizure Disorder
Asthma
Rescue Inhaler
None of these conditions apply to me
*Medications

This is a required entry. Please list all of your current medications. If none please enter "none"

*Current Health Issues that may need addressed at conference

This is a required entry. If none please enter "none"

6 - Refund and Cancellation Policy
*WPAUMC Refund and Cancellation Policy

Click Here to view the Refund and Cancellation Policy.

Yes, I have AGREE with the WPAUMC Refund and Cancellations Policy
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