Date
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Child's Name
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Child's Date of Birth
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Parent Names
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Parent's Mailing Address
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Parent Email Addresses
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Parent's Primary Phone
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Parent's Secondary Phone
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Food allergies or other medical conditions (type none if there aren't any)
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Questions or Comments
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I hereby give my consent as the parent/guardian of the above named child to attend/participate in the Mornings with Mommy program at Grace Lutheran Church, 7000 Providence Road, Charlotte, NC 28226. 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 Grace 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 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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