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Option 1 Option 2 Option 3

* Indicates required field

Parent's Name *

First

Last

Email Address *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Number of Children Attending *

1 2 3 4

Name(s) of child(ren) *

If this is your first time how did you hear about us? *

Does your child have any food allergies or medical concerns we need to be aware of? *

Yes No

If you answered "yes" above, please indicate allergies or medical concerns your child(ren) might have. *

Please enter "none" if your child is free of allergies or other medical concerns.

Please check the box if you are interested in receiving information about any of the following: *

Information about St. Peter Lutheran Church Information about St. Peter Preschool Information about upcoming children's activities

Check the box if interested.

Please type your first and last name below to give your consent. *

I hereby give my consent as the parent/guardian of the above named child/children to attend/participate in the Mornings With Mommy program at St. Peter Lutheran Church at 3461 Merle Ave, Modesto, CA 95355. 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 Mornings With Mommy. I hereby authorize St. Peter 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.

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We worship each Sunday at 9:00am
Worship is the beating heart of the Christian faith and an important part of life at St. Peter. We hope you join us soon!