House of Mercy 2017-2018 Family Registration
For infants through high school
Parent/guardian first and last name(s) *
Your answer
Address City, State Zip *
Your answer
preferred email address(es) *
Your answer
Phone number(s)
Your answer
Do you give permission for House of Mercy to use photographs or video of your child(ren) in church publications? No names will ever be used. Check all that apply: *
Required
Classroom helper - for younger age groups, I am willing to occasionally be the helper in my child's classroom in order to have safe ratios of children versus adults. *
Child's first and last name
Your answer
birthday MM/DD/YYYY
Your answer
grade in school (if applicable)
Your answer
name of school
Your answer
comments about your child (allergies, special needs, etc)
Your answer
Child's first and last name
Your answer
birthday MM/DD/YYYY
Your answer
grade in school (if applicable
Your answer
name of school
Your answer
comments about your child (allergies, special needs, etc)
Your answer
Child's first and last name
Your answer
birthday MM/DD/YYYY
Your answer
grade in school (if applicable
Your answer
name of school
Your answer
comments about your child (allergies, special needs, etc)
Your answer
Child's first and last name
Your answer
birthday MM/DD/YYYY
Your answer
grade in school (if applicable
Your answer
name of school
Your answer
comments about your child (allergies, special needs, etc)
Your answer
Submit
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