Messy Church registration form

Messy Church registration form
Parent / Carers Name (1)*

First NameLast Name
Parent / Carers Name (2)

First NameLast Name
Childs Name (1)*

First NameLast Name
Birth Date*

MonthDayYear
Gender
Childs Name (2)

First NameLast Name
Birth Date

MonthDayYear
Gender
Childs Name (3)

First NameLast Name
Birth Date

MonthDayYear
Gender
Address*

Street Address Line 2

CityState / Province

Postcode
Email*
example@example.com
Mobile Number*
Home Telephone Number
Additional Comments ie Dietary Needs
I would like to be kept informed about Messy Church by:

EmailText
Please tick one option below. I give permission for photos of me/my children taken at Messy Church by the official photographer to be used for Brighstone and Shorwell Methodist Church & St Marys Church publicity (church magazine, newsletter, websites). I am aware that this church will always ensure the pictures are respectful in their nature and appropriate to the activity promoted, and that no link can be made between the image of my child and his/her full name, address, email, etc. in order to avoid personal information being displayed or accessed publicly.*

I agreeI disagree
Should be Empty: