LCC Children's Ministries Registration Form
Welcome! Please fill out the following form with info as of the 2017-18 school year.
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    If you only have a cell phone, please list it here as well as below.
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  • Children's Ministries Participation & Medical Release Form

  • 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.

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  • 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

  • Please list the first & last name as you wish it to appear on the child's nametag.
  • Type in N/A if this child has no allergies or special needs.
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  • Authorized 1
    Authorized 2
    Authorized 3
    Authorized 4
    These names will print out on CHILD 1's nametag.
  • Examples: ONLY Jane Doe may pick up CHILD 1.
    Restraining order: John Doe is not allowed near CHILD 1.
  • CHILD 2

  • Please list the first & last name as you wish it to appear on the child's nametag.
  • Type in N/A if this child has no allergies or special needs.
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  • Authorized 1
    Authorized 2
    Authorized 3
    Authorized 4
    These names will print out on CHILD 2's nametag.
  • Examples: ONLY Jane Doe may pick up CHILD 2.
    Restraining order: John Doe is not allowed near CHILD 2.
  • CHILD 3

  • Please list the first & last name as you wish it to appear on the child's nametag.
  • Type in N/A if this child has no allergies or special needs.
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  • Authorized 1
    Authorized 2
    Authorized 3
    Authorized 4
    These names will print out on CHILD 3's nametag.
  • Examples: ONLY Jane Doe may pick up CHILD 3.
    Restraining order: John Doe is not allowed near CHILD 3.
  • CHILD 4

  • Please list the first & last name as you wish it to appear on the child's nametag.
  • Type in N/A if this child has no allergies or special needs.
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  • Authorized 1
    Authorized 2
    Authorized 3
    Authorized 4
    These names will print out on CHILD 4's nametag.
  • Examples: ONLY Jane Doe may pick up CHILD 4.
    Restraining order: John Doe is not allowed near CHILD 4.
  • Thank you for completing the LCC Children's Ministries Registration form.