Playgroup Registration Winter 2022

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Messiah Playgroup Registration Form. Our first class will be MONDAY January 24, 2022 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:

Email *

Child's Name *

Child's Date of Birth *

Child's Address *

Home Phone number

Home Church (if any)

I give Messiah permission to use photos of my child and myself in future promotional material and/or social media? *

Yes

Allergies or Health Issues we should be aware of:

Name of Adult Participating with child in Playgroup *

Mother's Name & Phone Number

Father's Name & Phone Number

Emergency Contact Name & Number

I give permission for my child to participate in Playgroup at Messiah. *

Yes

Required

Parent Signature *

Date: *

YYYY

Send me a copy of my responses.

Submit

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