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WeeCare Registration
A mother's day out program
Helmar Lutheran Church
Newark, Illinois
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* Indicates required question
Email
*
Your email
Child's Name
*
Your answer
Child's birthdate
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MM
/
DD
/
YYYY
Parents/Guardians Names
*
Your answer
Address
*
Your answer
Email
*
Your answer
Primary Contact Phone with name
*
Your answer
Secondary Contact Phone with name
*
Your answer
Home church
Your answer
Allergies or medical concerns
Your answer
My child's photograph may be used for the purpose of publications and/or on the church's website as part of the children's ministry program at Helmar Lutheran Church.
*
Yes
No
What are three of your child's favorite things to do?
Your answer
Anything else you would like us to know?
Your answer
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