Date of Session You Are Registering For:*
Name(s) and Age(s) of Child(ren) Attending:
Name of Adult Accompanying Child(ren):
City, State, Zip Code:
Allergies (If multiple children, please indicate child's name and allergies):
Do you have a place of worship where you attend?
I hereby give my consent as the parent/guardian of the above named child/children to attend/participate in the Time for Tots program at Cross of Christ Lutheran Church at 8131 Soule Rd., Liverpool, NY 13090. 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 Time for Tots.
Please type your name in the following box agreeing with this consent form.*
I hereby authorize Cross of Christ 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. (e.g. "Action shots" of Time for Tots sessions on our Facebook page, website, or brochure. We will not use your name or your children's names.)
Please type your name in the following box agreeing with this consent form.
How did you hear about Time for Tots?
E-Mail Address (To receive a receipt of your submitted form):*