Registration Form for Messy Church @ St Philip's

  • Name 1 *
    First
    Last
     
    Add names of all members in this family/group. Must include 1 adult.
  • Name 2
    First
    Last
     
  • Name 3
    First
    Last
     
  • Name 4
    First
    Last
     
  • Name 5
    First
    Last
     
  • Any Dietary needs we should know about??
    Please identify any dietary needs we should be aware of as we prepare the meals for Messy Church. Please identify who has the need.
  • Address
    Street Address
    Address Line 2
    City
    State / Province / Region
    Zip / Postal Code
    Country
     
  • email *
  • email other
  • Preferred Phone Number *
    (###)
    -
    ###
    -
    ####
     
  • Alternate Phone Number
    (###)
    -
    ###
    -
    ####
     
  • Are you interested in joining the St Philip's Messy Church Facebook group?
    Yes
    No
  • How should we keep you informed about Messy Church? *
    email
    text
  • I would be interested in helping at Messy Church with?
    set-up
    cooking
    clean up
    activities
    singing/music
  • I would be interested in supporting this Messy Church financially:
    Yes - please send me details
    No thanks
  • Permission: *
    I give
    I do not give
    Permission for photos of my/my children taken at Messy Church by our photographer to be used for this church's publicity (reports, newsletters, websites). I am aware that this church will ensure the pictures are respectful in their nature and appropriate to the activity promoted, and that no link can be made between the image of my child and his/her full name, address, email, etc. to avoid personal information being displayed or accessed publicly.
  • Name of person completing this form: *
    First
    Last
     
  • Today's date:
    MM
    /
    DD
    /
    YYYY