2019 Playgroup Registration
Messiah Playgroup Registration Form. Our first class will be January 28, 2019 at 9AM. Register for Playgroup by filling out the information below:
Email address *
Child's Name *
Your answer
Child's Date of Birth *
Your answer
Child's Address *
Your answer
Home Phone number
Your answer
Home Church (if any)
Your answer
I give Messiah permission to use photos of my child and myself in future promotional material and/or social media? *
Allergies or Health Issues we should be aware of:
Your answer
Name of Adult Participating with child in Playgroup *
Your answer
Mother's Name & Phone Number
Your answer
Father's Name & Phone Number
Your answer
Emergency Contact Name & Number
Your answer
I give permission for my child to participate in Playgroup at Messiah. *
Required
Parent Signature *
Your answer
Date: *
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