Tyler Memorial United Methodist Church - Chillicothe, Ohio
Making disciples with love to God and others

Registration Form can be found below.

Registration Form
Please fill out as many questions as possible to complete your registration.

What was the students last grade completed in 2010?
Child's Full Name?
Date Of Birth MM/DD/YYYY
Age
Male or Female? Male
Female
Parent's Name?
City
State
Zip
Home Phone Number? (740-XXX-XXXX)
Cell Phone Number? (740-XXX-XXXX)
E-mail

Name of another person to contact in case of emergency?
Other Contacts Phone Number? (740-XXX-XXXX)
Is there a special friend your child would like to be with?
Transportaion Needed? Yes
No

List food allergies or any other conditions which may limit activity:
Church presently attending?

  





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