Childcare or Sunday School
by filling out the information below:
You may register
more than one
child using this form.
FIRST Name of Child/Children
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. 2017:
REGISTER for: (Check ALL Events that apply)
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)
MOPS - Childcare (Sept-May)
Wednesday AM - Summer Study Childcare
Wednesday PM - Childcare
Thursday AM - Childcare
Celebrate Recovery - Childcare
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.
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.
Other: please note in Emergency Contact section
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?
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!