Playgroup Registration Winter Spring 2021
Messiah Playgroup Registration Form. Our first class will be TUESDAY February 16, 2021 at 9AM. Activities are designed to be readily accessible to two-year-olds. We could have children from newborn to 4, depending on the group dynamics. We ask that adult participants wear a mask. Children will not need to wear a mask. Register for Playgroup by filling out the information below:
* Required
Email address
*
Your email
Child's Name
*
Your answer
Child's Date of Birth
*
Your answer
Child's Address
*
Your answer
Home Phone number
Your answer
Home Church (if any)
Your answer
I give Messiah permission to use photos of my child and myself in future promotional material and/or social media?
*
Yes
No
Allergies or Health Issues we should be aware of:
Your answer
Name of Adult Participating with child in Playgroup
*
Your answer
Mother's Name & Phone Number
Your answer
Father's Name & Phone Number
Your answer
Emergency Contact Name & Number
Your answer
I give permission for my child to participate in Playgroup at Messiah.
*
Yes
Required
Parent Signature
*
Your answer
Date:
*
MM
/
DD
/
YYYY
Send me a copy of my responses.
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