LAMB Registration
Learning And Mommy Bonding
8 week sign up $50 per session / $10 discount if registered and pay in full for all three
mentorumc.org/onlinegiving or cash/check payable to Mentor UMC

9:00-11:00 AM

TUESDAYS:
FALL--September 25; October 2, 9, 16, 23, 30; November 6, 13
WINTER--January 8, 15, 22, 29; February 5, 12, 19, 26
SPRING--March 19, 26; April 2, 9, 16, 23, 30; May 7

THURSDAYS:
FALL--September 27; October 4, 11, 18, 25; November 1, 8, 15
WINTER--January 10, 17, 24, 31; February 7, 14, 21, 28
SPRING--March 21, 28; April 4, 11, 18, 25; May 2, 9

Parent’s Last Name *
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Parent’s First Name *
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Child’s Full Name *
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Child’s Date of Birth *
MM
/
DD
/
YYYY
Child’s Gender *
Which Session? *
Required
Primary Phone Number *
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Is this a mobile phone? *
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Primary Email Address *
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Home Address *
Your answer
Any allergies, dietary restrictions, or other concerns you would like to share *
Please share ANY concerns regarding allergies, dietary restrictions, etc.
Your answer
My child has permission to have nut-free snacks *
Additional information to share
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Emergency Contact Name *
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Emergency Contact Phone Number *
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Emergency Contact Relationship to Child *
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Child’s Doctor & Phone Number *
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Preferred Hospital
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Emergency Waiver~ In the event that reasonable efforts to contact me have been unsuccessful, I hereby give my consent for emergency medical treatment by a certified first aid giver. In the event that additional treatment is needed, the staff of the Emergency Department of the hospital listed above or the closest one to the event location, has my permission to treat my child.
Hospitalization Plan and Group #
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Typing your name here constitutes an electronic signature confirming everything is correct and acknowledgment of payment needed. *
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