First Methodist Church - Claremore

CONNECTION NIGHT IS CANCELLED DUE TO WEATHER

Event

Name of Parent or Guardian

First Name

Last Name

Email

Phone Number

Name of child

First Name

Last Name

Age

Grade

Allergies

Special Needs:

Message

Health Insurance Information

My child has permission to receive medical treatment in the event of an emergency and I cannot be reached.

Signature

Claremore FMC | 918.341.4580 | 1615 N. Hwy. 88 | Claremore, OK 74017