Parents' Names (required, First and Last)

    Address (required)

    Email Address

    Phone Number (required)

    What church do you attend? (if any)

    Emergency Contact Name (required)

    Emergency Contact Phone Number (required)

    Emergency Contact Address

    Emergency Contact Relationship to Child/Family


    Child 1 - Name (required, First and Last)

    Child 1 - Birthday YYYY-MM-DD (required)

    Child 1 - Last Grade Completed

    Child 2 - Name (First and Last)

    Child 2 - Birthday YYYY-MM-DD

    Child 2 - Last Grade Completed

    Child 3 - Name (First and Last)

    Child 3 - Birthday YYYY-MM-DD

    Child 3 - Last Grade Completed

    Child 4 - Name (First and Last)

    Child 4 - Birthday YYYY-MM-DD

    Child 4 - Last Grade Completed


    If your child(ren) has any allergies or medical issues that we need to be aware of, please list them below:


    We periodically take pictures of the children in our classrooms, during special events, and during worship services. These pictures are sometimes posted online on our website and social media pages, which are accessible by the public. Names of the children pictured are not posted. However, if you wish that Jackson UMC does not post a picture of your child, please check the box below:
    I do not want my child pictured in any photos accessible through jacksonumc.org, facebook.com/jacksonumc, twitter.com/jacksonumc, or instagram.com/jackson_umc


    Captcha (required)