Parent Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Who has custody of the child?

Father

Mother

Both

Other

Are you currently affiliated with a church?

Yes

No

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

YES

NO

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

No