Registration
Ages 3 to 10

2017 Christmas for Kids Registration
December 2, 2017
9-11 am
Messiah Lutheran Church
3186 Eaton Rd
Green Bay, WI 54311

Child #1 *
First and Last
Your answer
Child # 1 Age *
Child #2
First and Last
Your answer
Child # 2 Age
Child #3
First and Last
Your answer
Child # 3 Age
Child #4
First and Last
Your answer
Child # 4 Age
Parent/Guardian Name *
First and Last
Your answer
Address *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Email address
Your answer
Phone *
Your answer
Emergency Contact *
Please list contact name and phone #
Your answer
Who, other than you, has permission to pick up your child/children?
Your answer
Do you have a home church?
If yes, where?
Your answer
Allergies/Special Needs
Your answer
I hereby give my consent as the parent/guardian of the above named child/children to attend/participate in this event at Messiah Lutheran Church at 3186 Eaton Rd, Green Bay WI 54311. 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 this event. I hereby authorize Messiah 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 check yes to confirm. *
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