Toddler Gym Registration 2017-2018
Lititz Church of the Brethren
300 W. Orange Street--Lititz, PA 17543
Phone: 717-626-2131 Fax: 717-626-8031

October 19th (Thursday)- March 15 (Thursday)
October 20th (Friday)- March 16 (Friday)

For children up to Pre-K, Toddler Gym meets Thursdays and Fridays, 9:30 a.m.-10:30 a.m. in the Family Life Center at the rear of our church. The guidelines for this program can be found at Please complete a form for each child.

Registration will close on September 30 or when registration fills. You will receive a confirmation email by October 6th.

Last name of parent/guardian
Your answer
First name of parent/guardian
Your answer
Phone #1
Your answer
Text ?
Phone #2
Your answer
Email Address 1
Your answer
Email Address 2 (optional)
Your answer
Last Name of Child
Your answer
First Name of Child
Your answer
Date of Birth (mm/dd/yyyy)
Your answer
Please indicate which session you would like to attend.
Name of home church, if you have one.
Your answer
Terms of Agreement
By submitting this electronic form, I agree to follow the guidelines of Toddler Gym. I choose to release Lititz Church of the Brethren, their members and leadership, and anyone else that may be in charge of this activity, from all liability for any injury or accident which might befall my child while he/she is on the premises of Lititz Church of the Brethren. I have read the current guidelines and will be responsible for my child's safety at all times. I give permission for my child to be included in any photographic and/or video publications of Toddler Gym understanding that the name of my child will not be used without my permission.
Person submitting this form
Your answer
Relationship to child
Your answer
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