Paint & Play Registration
Thank you for registering for Paint & Play at Jeremiah Café! Please complete the information below to register your child/ren.
Parent/Guardian Information
Guardian First Name
*
Guardian Last Name
*
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Would you like to receive Jeremiah Café’s newsletter and event updates?
*
Yes please!
No thank you
Child Information
Child Information
*
Would you like to register another child?
*
Yes
No
Add another child entry if needed.
Repeat the child entry block for each additional child.
Additional Information
Are there any sensory needs or accommodations we should be aware of to help your child have the best experience possible?
Are there any dietary restrictions, allergies, or food sensitivities we should know about?
Photography & Social Media Permission
Photography & Social Media Consent
*
I give permission for Jeremiah Café to use photographs/videos taken during the event on social media, marketing materials, and promotional content.
Event Attendance Acknowledgment
*
I understand this is NOT a drop-off event and a parent/guardian must remain onsite during the event.
Date
-
Month
-
Day
Year
Date
Submit
Should be Empty: