Messy Church Light Party

Light Party

Saturday 28th October 6pm - 7:30pm Loanends Church Hall
Name of Parent/Guardian completing registration form*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent's Email Address*
example@example.com
Parent's Mobile Number in case of emergency *
Format: (00000000000).
Name of Second contact in case of emergency*

First NameLast Name
Second emergency contact number *
Format: (00000000000).
Name of Child attending

First NameLast Name
Birth Date

MonthDayYear
Medical and/or Dietary Needs
Primary Class*

Primary OnePrimary twoPrimary ThreePrimary FourPrimary FivePrimary SixPrimary Seven
Name of Child attending

First NameLast Name
Birth Date

MonthDayYear
Medical and/or Dietary Needs
Primary Class

Primary OnePrimary twoPrimary ThreePrimary FourPrimary FivePrimary SixPrimary Seven
Name of Child attending

First NameLast Name
Birth Date

MonthDayYear
Medical and/or Dietary Needs
Primary Class

Primary OnePrimary twoPrimary ThreePrimary FourPrimary FivePrimary SixPrimary Seven
Name of Child attending

First NameLast Name
Birth Date

MonthDayYear
Medical and/or Dietary Needs
Primary Class

Primary OnePrimary twoPrimary ThreePrimary FourPrimary FivePrimary SixPrimary Seven
I would like to receive information about future events for children, young people and families.*

yesNo
I give my permission for my child's/children's photographs to be taken and used on the churches' websites and Facebook pages.*

YesNo
Any further information that leaders may need to know
I confirm the information provided above is true and accurate.*

Please select to confirm
Should be Empty: