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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, December 9th at 10:00 am - Happy Birthday Jesus
 Monday, January 6th at 10:00 am - Moon, Stars, and Night Time
 Monday, February 3rd at 10:00 am - All About Me
 Monday, March 2nd at 10:00 am - Monkeys, Zebras, and Zoos
 Monday, April 6th at 10:00 am - Easter & Eggs
 Monday, May 4th at 10:00 am - Raccoons, S'mores, and Camping
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?*
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.*