REGISTRATION FOR CONFIRM

(one form per student)

Student's First name*

Last name*

Student's Birthday*

Student's Grade*

Student's Phone

Parents' Gardians' Names*

Parents' Phone (s)*

Parents' Email*

Home Address*

What is the best way to reach student or parent*

440.593.2525

110 Gateway Ave.
Conneaut, OH 44030

CHILDCARE

440.593.3330

110 Gateway Ave.

Conneaut, OH 44030

@2023 New Leaf United Methodist Church

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