EmailMe Form - LCC Children's Ministries Registration Form

Today's date *

MM / DD / YYYY

Parent/Guardian's Name (1) *

First Last

Parent/Guardian's Name (2)

First Last

Parent's/Guardian's Address *

Street Address City State / Province / Region Postal / Zip Code

Home Phone - last four digits will be used for electronic check-in) *

### - ### - ####

If you only have a cell phone, please list it here as well as below.

Cell Phone

### - ### - ####

Email

Confirm

We endeavor to provide a safe, fun and quality program. Parents, you are the key! Would you be willing to chat about ways you can partner with us in ministry? *

Definitely!

Maybe...

No way.

I usually attend the: *

6:00pm service Saturday

9:00am service Sunday

11:00am service Sunday

Children's Ministries Participation & Medical Release Form

Child's Name *

First Last

Child's Name

First Last

Child's Name

First Last

Child's Name

First Last

By clicking YES below, filling in my name and today's date, I give permission for my above named child/children to participate in Children's Ministries at Lighthouse Christian Center. By clicking YES, filling in my name and today's date below, I give permission for those in charge to obtain necessary medical attention for my child in case of sickness or injury to my child/children. Additionally, I do hereby release and hold harmless all sponsors, volunteers, and employees of Lighthouse from any and all claims, demands, actions or cause of action arising out of any damage or injury to me or my child/children while participating in programs at Lighthouse Christian Center.

Checkbox *

YES, I agree that entering my name and today's date below acts as my signature.

Authorized Parent/Guardian *

First Last

Relationship to Child/Children *

Today's Date *

MM / DD / YYYY

We exist to demonstrate God's love through Christ-centered relationship so that, as kids experience God's love, they choose to follow Jesus and help others do the same.

CHILD 1

CHILD 1's Name

First Last

Please list the first & last name as you wish it to appear on the child's nametag.

Does CHILD 1 have a different mailing address than the address listed for Parent's/Guardian's? *

Yes, the address for CHILD 1 is different than Parent's/Guardian's.

No, the address for CHILD 1 is the same as Parent's/Guardian's.

CHILD 1's Address (different than Parent's/Guardian's) *

Street Address City State / Province / Region Postal / Zip Code Country / Region

CHILD 1 Allergies/Special Needs *

Type in N/A if this child has no allergies or special needs.

Birth date of CHILD 1 *

MM / DD / YYYY

CHILD 1 is in grade *

CHILD 1 enters Kindergarten *

MM / YYYY

CHILD 1 is currently attending what school? *

Please list the (first & last) names of people who are authorized to pick up CHILD 1.

Authorized 1
Authorized 2
Authorized 3
Authorized 4

These names will print out on CHILD 1's nametag.

Does CHILD 1 have any security concerns? *

Examples: ONLY Jane Doe may pick up CHILD 1.
Restraining order: John Doe is not allowed near CHILD 1.

As the parent/guardian of CHILD 1, I give LCC permission to use CHILD 1's photo on the LCC website.
www.lighthousehome.org *

Yes, I give my permission.

No, I do not give my permission

Do you have a second child to register?

Yes, I have a second child to register.

No, I am done.

CHILD 2

CHILD 2's Name

First Last

Please list the first & last name as you wish it to appear on the child's nametag.

Does CHILD 2 have a different mailing address than the address listed for Parent's/Guardian's? *

Yes, the address for CHILD 2 is different from Parent's/Guardian's but is the same as CHILD 1.

Yes, the address for CHILD 2 is different from both the Parent's/Guardian's and CHILD 1 .

No, the address is the same.

CHILD 2's Address (different than Parent's/Guardian's & CHILD 1) *

Street Address City State / Province / Region Postal / Zip Code Country / Region

CHILD 2 Allergies/Special Needs *

Type in N/A if this child has no allergies or special needs.

Birth date of CHILD 2 *

MM / DD / YYYY

CHILD 2 is in grade *

CHILD 2 enters Kindergarten *

MM / YYYY

CHILD 2 is currently attending what school? *

Please list the (first & last) names of people who are authorized to pick up CHILD 2.

Authorized 1
Authorized 2
Authorized 3
Authorized 4

These names will print out on CHILD 2's nametag.

Does CHILD 2 have any security concerns? *

Examples: ONLY Jane Doe may pick up CHILD 2.
Restraining order: John Doe is not allowed near CHILD 2.

As the parent/guardian of CHILD 2, I give LCC permission to use CHILD 2's photo on the LCC website.
www.lighthousehome.org *

Yes, I give my permission.

No, I do not give my permission

Do you have a third child to register? *

Yes, I have a third child to register.

No, I am done.

CHILD 3

CHILD 3's Name

First Last

Please list the first & last name as you wish it to appear on the child's nametag.

Does CHILD 3 have a different mailing address than the address listed for Parent's/Guardian's? *

Yes, the address for CHILD 3 is different from Parent's/Guardian's but is the same as CHILD 1 & CHILD 2.

Yes, the address for CHILD 3 is different from all including the Parent's/Guardian's and CHILD 1 & CHILD 2.

No, the address is the same.

Other

CHILD 3's Address (different than Parent's/Guardian's, CHILD 1 and CHILD 2) *

Street Address City State / Province / Region Postal / Zip Code Country / Region

CHILD 3 Allergies/Special Needs *

Type in N/A if this child has no allergies or special needs.

Birth date of CHILD 3 *

MM / DD / YYYY

CHILD 3 is in grade *

CHILD 3 enters Kindergarten *

MM / YYYY

CHILD 3 currently what school? *

Please list the (first & last) names of people who are authorized to pick up CHILD 3.

Authorized 1
Authorized 2
Authorized 3
Authorized 4

These names will print out on CHILD 3's nametag.

Does CHILD 3 have any security concerns? *

Examples: ONLY Jane Doe may pick up CHILD 3.
Restraining order: John Doe is not allowed near CHILD 3.

As the parent/guardian of CHILD 3, I give LCC permission to use CHILD 3's photo on the LCC website.
www.lighthousehome.org *

Yes, I give my permission.

No, I do not give my permission

Do you have a fourth child to register? *

Yes, I have a fourth child to register.

No, I am done.

CHILD 4

CHILD 4's Name

First Last

Please list the first & last name as you wish it to appear on the child's nametag.

Does CHILD 4 have a different mailing address than the address listed for Parent's/Guardian's? *

Yes, the address for CHILD 4 is different from Parent's/Guardian's but is the same as CHILD 1, 2, & 3.

Yes, the address for CHILD 4 is different from all including the Parent's/Guardian's, CHILD 1, 2, & 3..

No, the address is the same.

Other

CHILD 4's Address (different than Parent's/Guardian's, CHILD 1, 2, & 3) *

Street Address City State / Province / Region Postal / Zip Code Country / Region

CHILD 4 Allergies/Special Needs *

Type in N/A if this child has no allergies or special needs.

Birth date of CHILD 4 *

MM / DD / YYYY

CHILD 4 is in grade *

CHILD 4 enters Kindergarten *

MM / YYYY

CHILD 4 is currently attending what school? *

Please list the (first & last) names of people who are authorized to pick up CHILD 4.

Authorized 1
Authorized 2
Authorized 3
Authorized 4

These names will print out on CHILD 4's nametag.

Does CHILD 4 have any security concerns? *

Examples: ONLY Jane Doe may pick up CHILD 4.
Restraining order: John Doe is not allowed near CHILD 4.

As the parent/guardian of CHILD 4, I give LCC permission to use CHILD 4's photo on the LCC website.
www.lighthousehome.org *

Yes, I give my permission.

No, I do not give my permission

Children's Ministries Participation & Medical Release Form

We exist to demonstrate God's love through Christ-centered relationship so that, as kids experience God's love, they choose to follow Jesus and help others do the same.

CHILD 1

CHILD 2

CHILD 3

CHILD 4

Thank you for completing the LCC Children's Ministries Registration form.