Wee Hearts Mother's Day Out 
WEST HOUSTON CHURCH OF CHRIST
REGISTRATION FORM

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I am registering my child for the following: *
Please Indicate New or Returning Student below: *
1st Child’s name: *
2nd Child’s Name:
1st Child’s Date of Birth  *
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Age of Child as of Sept 2, 2025:
2nd Child's Date of Birth
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Age of child as of Sept. 2, 2025:
Parent(s) Names
Parents Address
Please include City and Zip Code
Parent(s) Phone Number:
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