Play and Learn Class Registration
Precious Gems is now hosting Play and Learn classes at Crown of Glory Lutheran Church beginning September 5th at 10:00am. Classes will be held for one hour for children between the ages of 0-5 with their caregiver. Please fill out one registration form per child. Registration is $5 per week and will be collected on site.
Child's Full Name *
Your answer
Date of Birth *
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Sex
Street Address (street, city, zip code)
Your answer
Home Phone Number *
Your answer
Mother's Information (Name, Email, Cell Phone, Work Phone)
Your answer
Father's Information (Name, Email, Cell Phone, Work Phone)
Your answer
Does your child have any allergies or medical conditions that we need to be aware of? *
Your answer
Church Affiliation (if any)
Your answer
How did you hear about Precious Gems/Crown of Glory
I give permission to have both mine and/or my child's picture taken during class time, which may be used publicly or privately by Precious Gems or Crown of Glory. *
For electronic signature from parent, please indicate today's date that you are completing this registration form.
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