Sprigs & Sprouts Enrollment

Fredonia First United Methodist Church

Grades K–4 | Enrollment Form

Please complete the enrollment form below for every child from your household who will be attending Sprigs & Sprouts. Fields marked with * are required.

Program Information

Sprigs & Sprouts is for children in kindergarten through fourth grade. The program begins at 8:00 a.m. with breakfast, includes lunch, and dismisses at 3:00 p.m.

Children Enrolling

Child 1

Child’s full name

Grade

Birthdate

Child 2

Child’s full name

Grade

Birthdate

Child 3

Child’s full name

Grade

Birthdate

Child 4

Child’s full name

Grade

Birthdate

Contact Information

Home address

Mailing address (if different)

Parent or guardian name

Cell phone

Parent or guardian email address The church may use this address to contact you about this enrollment or Sprigs & Sprouts.

Second parent or guardian (optional)

Cell phone (optional)

Home or work phone (optional)

Emergency Contact

Please list someone other than the child’s parent or guardian who may be contacted if the parent or guardian cannot be reached.

Emergency contact name

Relationship

Home phone (optional when a cell number is provided)

Cell phone (optional when a home number is provided)

Personal Information

Food allergies (enter “None” when applicable)

Other allergies (enter “None” when applicable)

Communication, disability, or other information that would be helpful for us to know

Permissions

I give permission for Fredonia First United Methodist Church to transport my child for approved Sprigs & Sprouts activities.

Parent initials

Yes, I grant transportation permission.

I give permission to photograph or record video of the minor child or children designated above for lawful purposes associated with this program, including use on the church website and social media.

Parent initials

Yes, I grant photography and video permission.

The people listed below have my permission to pick up my child or children.

Parent initials

Yes, I authorize the people listed below to pick up my child or children.

My child or children have permission to leave Sprigs & Sprouts on their own and walk home.

Parent initials

Yes, my child or children may leave on their own and walk home.

Authorized Pickup People

Authorized Person 1

Full name

Relationship

Contact number

Authorized Person 2

Full name

Relationship

Contact number

Authorized Person 3

Full name

Relationship

Contact number

Important Pickup and Medication Information

The church will not dispense prescription or over-the-counter medications.

In the event of illness or behavioral concerns, the parent or guardian will be contacted and asked to pick up the child.

Parent or Guardian Signature

Parent or guardian printed name

Date

Electronic signature Type your full legal name as your electronic signature.

I certify that the information submitted is accurate. I understand that typing my name above and submitting this form represents my electronic signature.

Please press the submit button only once. It may take a few seconds for your enrollment to be sent.