Spiritual Play Child Registration Form 2024

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Thank you for your interest in Shadow Rock Spiritual Play! Join us for this 2 ½ hour pilot program on Sunday mornings to explore experiences in everyday life that present a wealth of opportunities to nurture and enhance spiritual development. This program is for children ages 3*-6. *Children must be potty trained.

Dates of the pilot program are Sundays: Jan. 14, Jan. 21, Jan. 28, Feb. 4, Feb. 11 and Feb. 18.

You can reach Cindy Hoard with any questions at any of the following: drcindyhoard@gmail.com, drcindy@shadowrockucc.org, or 602-616-9682.

Please complete the required fields below.

Email *

Child's First Name *

Child's Last Name *

Date of Birth *

YYYY

Gender *

Parent/Guardian Name *

Phone Number (Please enter in this format 555-123-4567) *

Address *

2nd Emergency Contact Name (not parent/guardian listed above) *

Phone Number (Please enter in this format 555-123-4567) *

Emergency Contact Relationship to Child *

Child's Allergies *

Medical Information you think we need to know *

Photo Preferences *

I prefer that spiritual play staff do NOT take pictures of my child

Pictures of my child may be used for bulletin boards and in-house publications

Pictures of my child may be used online for social media and the website (no names)

Required

Getting to Know Your Family. Please tell us anything that will help the Spiritual Play staff and volunteers serve your children and family better. Information is confidential. *

Are you interested in participating in a parent discussion group?

Yes

Maybe

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A copy of your responses will be emailed to the address you provided.

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