Mornings with Mommy
Parent/Caregiver First Name *
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Parent/Caregiver Last Name *
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Child 1 Name *
Your answer
Child 1 Age *
Child 2 Name
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Child 2 Age
Child 3 Name
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Child 3 Age
Address *
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City *
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Zip Code *
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Email address *
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Phone number *
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Are there any allergies or medical concerns that we need to be aware of? If yes, please list. If no, please write, "none." *
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Do you have a church home? *
If you do have a church home, where do you attend?
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I hereby give my consent as the parent/guardian of the above named child/ren to attend/participate in the Mornings with Mommy program at Christ Lutheran Church at 13009 N Elderberry Ct, Lodi, CA 95242. My child/ren 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 Christ 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 I 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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