Messy Church Registration Form

Name of family members at Messy Church (and date of birth optional for birthday celebrations).

1. Name

Date of Birth

2. Name

Date of Birth

3. Name

Date of Birth

4. Name

Date of Birth

5. Name

Date of Birth

6. Name

Date of Birth

Contact Information

Address

City, State, ZIP

E-mail

Home Phone

Cell Phone

Are there any allergies, dietary information or other information that would be helpful for us to know so we can make this experience more welcoming?

I am interested in belonging to the Messy Church Facebook group for this church.

YES

If Other, please Specify

Congratulations!! You are now registered to attend Messy Church.