Village Well Meeting Registration
Please register online by January 4 and include the names and ages of any children.  This helps us balance our classroom childcare needs.
Email address *
Name: *
(First & Last)
Your answer
Spouse Name:
(First & Last)
Your answer
Phone: *
Your answer
I/We are a: *
We are serving a free dinner for your whole family at 6 pm. Will you be joining us? *
Do you require childcare? *
Child #1 Name and Age
Your answer
Child #2 Name and Age
Your answer
Child #3 Name and Age
Your answer
Child #4 Name and Age
Your answer
Child #5 Name and Age
Your answer
A copy of your responses will be emailed to the address you provided.
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