JLM Registration

Pre-Registration for Jesus Loves Me Party (March 4th - 9am - NOON)

One form for EACH child. Please use PROPER CAPITALIZATION (upper and lower case letters)
Child's First Name*
Enter the first name as you would like it printed on the child's name tag
Child's Last Name*
Gender*

FemaleMale
Grade*

3K4K5KGrade 1Grade 2Grade 3Grade 4
Address*
Street Address
City*
State*
Zip Code*
E-mail*

Confirmation Email
Mother's Name
Mother's Mobile

Area CodePhone Number
Father's Mobile

Area CodePhone Number
Father's Name
Contact Person's Name and Phone Number (during party hours)*
Health - Physical limitations, medical conditions, allergies, etc.*

none
Please note Lunch will NOT be provided but a snack including Goldfish, String Cheese and Fruit will be. Parents of children with food allergies may wish to send your own snack.
Please note Lunch will NOT be provided but a snack including Goldfish, String Cheese and Fruit will be. Parents of children with food allergies may wish to send your own snack.
Home Church Name*

none
How did you hear about the Jesus Loves Me Party?*

FlyerWord-of-MouthPeace Lutheran Church/SchoolSocial MediaBanner/Poster
PERMISSION: I hereby give and grant my permission for my son(s)/daughter(s) to participate in the “Jesus Loves Me” Party sponsored by church and school. I do further agree to hold and save harmless the trustees, teachers and congregation of Peace Lutheran Church and School, Hartford, WI, from all suits, claims or demands of every kind and character arising out of, and in connection with this sponsored event.
By checking the box below, I am stating that I have read and understood the above statement, and that I agree with its terms. I also understand that checking the box below constitutes a legally-binding signature.*

I agree.
Your First & Last Name*
PHOTOGRAPHY PERMISSION: I understand that photos may be taken and used in the newspapers, and other promotional brochures and fliers. I also understand that selecting an option below constitutes a legally-binding signature.
Agree to Above Photography Statement*

I agree to the statement above.I do NOT want my child photographed.
Other information you would like us to know? (Including any request to keep your child in the same room with another child/friend)
Should be Empty:

Pre-Registration for Jesus Loves Me Party (March 4th - 9am - NOON)

Please note Lunch will NOT be provided but a snack including Goldfish, String Cheese and Fruit will be. Parents of children with food allergies may wish to send your own snack.