WeeCare Registration
A mother's day out program
Helmar Lutheran Church
Newark, Illinois
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Email *
Child's Name *
Child's birthdate *
MM
/
DD
/
YYYY
Parents/Guardians Names *
Address *
Email *
Primary Contact Phone with name *
Secondary Contact Phone with name *
Home church
Allergies or medical concerns
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. *
What are three of your child's favorite things to do?
Anything else you would like us to know?
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