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Mornings with Mommy Registration
Event Timing: August 23rd, 2019 at 10:00 a.m.
Event Address: 6150 N. Lecanto Hwy, Beverly Hills, FL 34465

Fun at the Farm!
Parent's First Name *
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Parent's Last Name *
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Email
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Phone Number *
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Street Address
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City, State and Zip Code
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Number of Children Attending
Name of First Child *
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Age of First Child
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Name of Second Child
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Age of Second Child
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Name of Third Child
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Age of Third Child
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Do any of your children have allergies or other medical concerns we need to be aware of? *
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Do you have a home church?
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If this is your first time with Mornings with Mommy, how did you hear about the group?
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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 Saint Paul's Lutheran Church at 6150 N. Lecanto Hwy, Beverly Hills FL 34465. My child and I hereby release, indemnify, and hold harmless the church, its employees and/or volunteers from any and all liability from any claim, injury, or loss sustained by or during my child's participation during Mornings With Mommy. I hereby authorize Saint Paul's 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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