Mornings with Mommy New Registration Parent's First Name * Parent's Last Name * Phone Number * Email Address * Address * City * State * Florida Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code * How many children will be with you? * 1 2 3 4 5 Name and Age of Children (1 per line) * example name, 4 years old Select a Date * March 26 Do any of the children have allergies or other medical concerns we need to be aware of? * How did you hear about us? * Do you have a home church? If yes, where? * Are you looking for a church? * Yes No Would you like more information about Risen Savior? * Yes No How would you like to pay? * Pay in Advance Via PayPal Pay in Person at Event (Cash Only) I hereby give my consent as the parent/guardian of the above named child/children to attend/participate in the Mornings with Mommy program at Risen Savior Lutheran Church at 14605 59th Ave E, Lakewood Ranch, FL. My child and I hereby release, indemnify, and hold harmless the church, its employees and/or volunteers from any and all liability, from any claim, injury, or loss sustained by or during my child's participation during Mornings With Mommy. I hereby authorize Risen Savior to take and use photography and/or video of my child for crafts, keepsakes, or promotional purposes in any type of media and understand I will not be compensated for any such use. PLEASE TYPE YOUR NAME IN THE BOX BELOW AGREEING TO THIS CONSENT FORM. * If you are human, leave this field blank.