Messy Church Registration Form
The information supplied on this form will be retained by our church on a database and will be used only for the administration of the Messy Church. It will not be disclosed to any third parties.

www.santamonicaumc.org/messychurch Contact: Tricia Guerrero: t.guerrero@santamonicaumc.org

Today's Date *
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Adult / Parent 1 Last, First Name *
Your answer
Adult / Parent 2 Last, First Name
Your answer
Child 1 Name + DOB + Dietary Needs
Your answer
Child 2 Name + DOB + Dietary Needs
Your answer
Child 3 Name + DOB + Dietary Needs
Your answer
Address
Your answer
Telephone *
Your answer
Email *
Your answer
Add to Private Messy Church Facebook Group? Email required
Interested in Volunteering at Messy Church? You will be contacted via email.
I give / do not give [mark as required] permission for photos of me and /or my children taken at Messy Church by our volunteer photographer to be used for this church's publicity (church newsletter, websites). I am aware that this church will always ensure the pictures are respectful in their nature and appropriate to the activity promoted, and that no link can be made between the image of my child and his/her full name, address, email etc. in order to avoid personal information being displayed or accessed publicly. *
Interested in supporting Messy Church financially?
How did you hear about Messy Church?
Your answer
Comments/Questions
Your answer
Signature *
Your answer
Submit
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