Play Care Registration form 2021/2022

2021/2022 Play Care Registration Form (click here)

2021-2022

Wesley United Methodist Church

209 S. State Street, Dover, DE 19901 – 678-8987

Wesley Play Care Registration Form

Registration Fee $55.00 – This fee is waived for children registered in Preschool.

Start Date:___________________________

Please print clearly!

Please list and be specific with days and times needed:

Days Needed:____________________________________

Times:___________________

____My child is a napper    ____My child is a non-napper

Child’s Name__________________________________   M___   F___

Nickname_____________________________________

BirthDate___________________Age_________________

Address_______________________________________________________

City________________________  State ___________  Zip _______________

Home Phone_____________________ Cell Phone______________________

Email________________________________________________________

Mother’s Name_______________________ Work Phone_________________ 

Father’s Name_______________________ Work Phone__________________

Legal Guardian______________________  Work Phone__________________ 

Emergency Contact________________________ Phone__________________

Preschool Class, if registered________________________________

Days & Times__________________

Note:  Preschool registration must take place on a separate form.  Please remember to notify the Preschool Office immediately if your original Play Care times change.