MWM: Moon, Stars, and Nighttime
Parent/Caregiver Last Name *
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Parent/Caregiver First Name *
Your answer
You are registering for Friday, February 21st: Moon, Stars, and Nighttime
Street Address (if this is your first time attending)
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City, State, Zip (if this is your first time attending)
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Phone Number *
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Please list the name(s) AND age(s) of the children attending: *
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Do any of the children have allergies or other medical concerns we should be aware of?
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How did you hear about our program?
Do you have a home church? *
If yes, what church do you belong to?
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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 Bethlehem Lutheran Church at N108W14290 Bel Aire Ln., Germantown, WI 53022. 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. Please type your full name in the box below agreeing with this consent form. *
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I hereby authorize Bethlehem 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 full name in the box below if you agree with this consent form. *
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