Henry Presbyterian Church

511 Wirt Street, P.O. Box 203,  Henry, Illinois, 309-364-3083

        Where the saving love of Jesus Christ is embraced in hospitality and ignited in service to the community

 

Home

About Us

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Contact Us

In the Beginning

Mission Statement

Our Ministries

Other Helpful Links

Kid's Korner

Flute Circle

Site Map

VBS Registration

 

 

 

 

 

 

Day Care Form

 

Child Information

 

Name of Child __________________________________________      Birthday  ____________________

 

Name of Child __________________________________________      Birthday  ____________________

 

Name of Child __________________________________________      Birthday  ____________________

 

Parent Information

 

Motherís Name  ______________________________           Fatherís ______________________________

 

Cell Number  _________________________________                       Cell Number__________________________

 

 

Other persons to notify if you canít be reached and allowed to pick up child

 

Name/ Relationship  _______________________________ Ph. Number__________________________

 

Name/ Relationship  _______________________________ Ph. Number __________________________

 

Name/ Relationship  _______________________________ Ph. Number __________________________

 

Doctor

 

Name _________________________________                        Hospital ______________________________________

 

List Allergies or medical issues _____________________________________________________________

 Print form and bring with your child/children when registering..

_________________________________________________________________________________________________

 

 

 

 
 
 
 
 
 
 

First Presbyterian Church * 511 Wirt Street * Henry, IL
  309-364-3083