August 21st 2025

JOYFUL PLAY THURSDAY
A FREE Moms & Children Play Day

Date: September 18th, 2025
Time: 9:00 AM – 11:00 AM
Who: Moms & Children ages 0–5

Enjoy a morning with your littles, meeting new moms, and having children interact with each other!
Free coffee and donuts provided!
Parent/Gaurdian Information
Name*

First NameLast Name
Phone Number*
E-mail*
example@example.com
How many Children will be attending?
Use the dropdown to select the number of children attending.
Children Information
#1 Child's Name*

First NameLast Name
#1 Child's Age (Years)
#1 Child Gender

MaleFemale
Does this child have any allergies, chronic illness, or medical conditions? If yes, please describe.
#2 Child's Name*

First NameLast Name
#2 Child's Age
#2 Child Gender

MaleFemale
Does this child have any allergies, chronic illness, or medical conditions? If yes, please describe.
#3 Child's Name*

First NameLast Name
#3 Child's Age
#3 Child Gender

MaleFemale
Does this child have any allergies, chronic illness, or medical conditions? If yes, please describe.
#4 Child's Name*

First NameLast Name
#4 Child's Age
#4 Child Gender

MaleFemale
Does this child have any allergies, chronic illness, or medical conditions? If yes, please describe.
#5 Child's Name*

First NameLast Name
#5 Child's Age
#5 Child Gender

MaleFemale
Does this child have any allergies, chronic illness, or medical conditions? If yes, please describe.
Informed Consent and Acknowledgement

I hereby give my approval for my children's participation in any and all activities prepared by ACC of North Phoenix during this time. I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless ACC of North Phoenix and all its respective volunteers, and representatives from any and all liability for injuries to said child arising out of participation in this event and activities. In case of injury to said children, I hereby waive all claims against ACC of North Phoenix including all volunteers.
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
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If you have any questions, please feel free to email us at info@accnorthphoenix.org
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Parent/Gaurdian Information

Children Information

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