JLM Registration

Registration - Jesus Loves Me Party (March)

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 *

Female Male
Grade *

3K 4K 5K Grade 1 Grade 2 Grade 3 Grade 4
Address *
Street Address
City *
State *
Zip Code *
E-mail *

Confirmation Email
Mother's Name
Mother's Mobile

- Area Code Phone Number
Father's Mobile

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

none
Since lunch is provided at the Jesus Loves Me Party, parents of children with food allergies may wish to send a bag lunch.

I will send a bag lunch with my child My child will eat the Jesus Loves Me Party lunch
Home Church Name *

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

Flyer Word-of-Mouth Peace Lutheran Church/School Social Media Banner/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:

Registration - Jesus Loves Me Party (March)