Mornings with Mommy

Parent Name*

First NameLast Name

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Area CodePhone Number

Reminder Confirmation*

Phone CallText Message

Child's Name*

Child's Age*

Child's Name

Child's Age

Child's Name

Child's Age

Medical Concerns - Allergies, physical limitations, medical conditions, etc.*

none

Home Church Name*

none

If this is your first time, how did you hear about Mornings with Mommy?

I hereby give my consent as the parent/guardian of the above named child/children to attend/participate in the Mornings With Mommy program at Amazing Grace Lutheran Church at 2240 Carolina Forest Blvd, Myrtle Beach, SC 29579. My child 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's participation during Mornings With Mommy. I hereby authorize Amazing Grace 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 in the box below agreeing with this consent form. *

Signature

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