Registration
Ages 3 to 10

2019 Easter for Kids Registration
April 13, 2019
9-11 am
Messiah Lutheran Church
3186 Eaton Rd
Green Bay, WI 54311
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Child #1 *
First and Last
Child # 1 Age *
Child #2
First and Last
Child # 2 Age
Child #3
First and Last
Child # 3 Age
Child #4
First and Last
Child # 4 Age
Parent/Guardian Name *
First and Last
Address *
City *
State *
Zip *
Email address
Phone *
Emergency Contact *
Please list contact name and phone #
Who, other than you, has permission to pick up your child/children?
Do you have a home church?
If yes, where?
Allergies/Special Needs
I hereby give my consent as the parent/guardian of the above named child/children to attend/participate in Easter for Kids at Messiah Lutheran Church at 3186 Eaton Rd, Green Bay WI 54311. 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 Easter for Kids. I hereby authorize Messiah Lutheran Church 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 enter your full name below to confirm. *
What is three plus seven? *
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