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Mornings with Mommy Registration

Parent's First Name:*
Parent's Last Name:*
Email Address:*
Street Address:*
City, State:*
Zip Code:*
What session would you like to register for?*
 Monday, September 9th at 10:00 am - Things That Go
 Monday, October 14th at 10:00 am - Colors and Shapes
 Monday, November 18th at 10:00 am - Harvest and Farms
 Monday, December 9th at 10:00 am - Happy Birthday Jesus
Number of Children Attending:*
Name of First Child Attending:*
Age of First Child Attending:*
Name of Second Child Attending:
Age of Second Child Attending:
Name of Third Child Attending:
Age of Third Child Attending:
Do any of the children have allergies or other medical concerns we need to be aware of?
Do you have a home church?*
 Yes
 No
I hereby give my consent as the parent/guardian of the above named child/children to attend/participate in the Mornings with Mommy program at Zion Evangelical Lutheran Church at W6906 County Road K, Arlington, WI 53911. My child and I hereby release indemnify, and hold harmless the church, its employees and/or volunteers from any and liability from any claim, injury, or loss sustained by or during my child's participation during Mornings with Mommy. I hereby authorize Zion Evangelical Lutheran Church to take and use photography and/or video of my child for crafts, keepsakes, or promotional purposes in any type of media and understand I will not be compensated for any such use. Please type your name in the box below agreeing with this consent form.*


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