Parent/ Guardian Name

First Name

Last Name

Phone

(###)

###

####

Number of Children Attending

One

Two

Three

Four

First Child's Name

First Name

Last Name

First Child's Date of Birth

Ages 0-5 only

YYYY

Second Child's Name

First Name

Last Name

Second Child's Date of Birth

Ages 0-5 only

YYYY

Third Child's Name

First Name

Last Name

Third Child's Date of Birth

Ages 0-5 only

YYYY

Fourth Child's Name

First Name

Last Name

Fourth Child's Date of Birth

Ages 0-5 only

YYYY

Do you have a church home?

Yes

Please type your name in the box below agreeing with this statement of consent.

I hereby give my consent as the parent/ guardian of the above named child(ren) to attend/ participate in the Mornings with Mommy program at Risen Savior Lutheran Church, 1755 Quacco Road, Pooler, GA 31322. My child(ren) and I hereby release, indemnify, and hold harmless the church, its employees, and/ or volunteers from any and all liability from any claim, injury, or loss sustained by or during my child(ren)'s participation during Mornings with Mommy. I hereby authorize Risen Savior to take and use photography and/ or video of my child(ren) for crafts, keepsakes, or promotional purposes in any type of media. I understand my child(ren)'s name will not be published with any promotional images and I will not be compensated for any such use.

Payment

Complete your registration by adding your selected Mornings with Mommy tickets to your cart. After adding items to your cart, navigate to your cart and checkout.

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