Momentum Registration

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Please fill out a new form for each child at the beginning of each school year.

Child's Name *

Parent Name *

Parent Phone number *

Emergency Contact Name (if parent cannot be reached) *

Emergency Contact Number *

Birthday *

YYYY

Grade (2025-2026) *

5th

6th

7th

8th

Home Address *

Allergies *

I give permission for my child to be photographed during fun activities. These photos might be used for slideshow presentations, social media (Living Water Facebook page only), and or the Living Water website. *

Yes, you may take photos of my child for the above use only

No, I do not want you to take pictures of my child

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