CHILDREN'S Registration

Register for Childcare, Celebrate Recovery or Sunday School by filling out the information below:

MOPS 2019-2020 registration. Please contact MOPS leader, Kelly Sutley, at kmsutley@gmail.com for childcare registration link OR go to MOPS page on this website.

You may register more than one child using this form.

FIRST Name of Child/Children

LAST Name

Home Address

ZIP Code

Phone (specifiy home or cell)

Parents or Caregiver NAME

PRIMARY Email Address

DATE OF BIRTH: List ALL children separately followed by Month/Day/Year

GRADE of each child as of Sept. 2019:

Sunday 9:00 AM - Childcare

Sunday 10:30 AM - Childcare

Kidz Korner for ages 5 - 2nd grade (during 9:00 service)

Sunday School (Sept-May during 10:30 service)

Tuesday PM - Childcare

Thursday AM - Childcare

Celebrate Recovery - Childcare (thru age 4)

Celebration Place (age 5 thru 5th gr)

ATTENTION 6th GRADERS: I/We give permission for our (my) student to ride in the vehicle designated by Lakeview's Staff or adult Volunteer in whose care he/she has been entrusted while attending and participating in Lakeview activities.

YES

Allergies? Please explain for each child:

Special Needs or Restrictions:

Permission to treat: In the event that I am not in the building and cannot be reached in an emergency, I hereby give permission to the designated Lakeview Parish Nurse and program coordinator to obtain emergency transport as needed, to the designated hospital.

yes

Doctor's name:

Hospital preference

Emergency Contact Names & Numbers in case parent cannot be reached:

PERMISSION to PICK UP my child: (must be 16 yrs or older)

May child's photo be included in Lakeview publications or website?

yes

Success! This form has been submitted. Please note this is not an automated registration system. Information is manually entered by staff during office hours. Thank you!