Growing Together Registration Form - December 28 @ 945am-11am

Parent/Caretaker First and Last Name

This address will receive a confirmation email

Phone

Address (Street,Ctiy,State, Zip)

# of Children Attending (up to age 5)

Names of Children Attending

Do any of the children have allergies or medical concerns we need to be aware of?

Do you have a home church?

Yes. No. Currently Looking for One Not interested at this time.

I hereby give my consent as the parent/caretaker of the above named child/children to attend/participate in the Growing Together program at Our Shepherd Lutheran Church (1515 W 93rd Ave., Crown Point, IN 46307). My child and I hereby release, idemnify, 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's paritcipation during Growing Together. Please write your full name (parent/caretaker) in the box below agreeing to this consent form.

I hereby authorize Our Shepherd Lutheran Church to take and use photography and/or video of my child for crafts, keepsakes, or promotional purposes in any type of media and understand I will not be compensated for any such use. Please type your name (parent/caretaker) in the box below agreeing to this consent form.

Payment

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

Please fill out this form and click submit.

Growing Together Registration Form - December 28 @ 945am-11am

Description

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