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
Date of Birth
Prefer not to say
Street Address (street, city, zip code)
Home Phone Number
Mother's Information (Name, Email, Cell Phone, Work Phone)
Father's Information (Name, Email, Cell Phone, Work Phone)
Does your child have any allergies or medical conditions that we need to be aware of?
Church Affiliation (if any)
How did you hear about Precious Gems/Crown of Glory
Crown of Glory website
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.
YES, I give permission
NO, I do not give permission
For electronic signature from parent, please indicate today's date that you are completing this registration form.
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