Event Registration

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MDPC Children's Ministry Registraton on Wednesday, November 17, 2021 @ 5:00 PM

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*The information above should be that of the child you are registering.*

CHECK THE APPROPRIATE BOX BELOW.

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*PLEASE COMPLETE A SEPARATE FORM FOR EACH CHILD BEING REGISTERED*
*FIRST Name child goes by:
*LAST Name goes by:
*Child's Birthdate:
*Child's Gender:
*Age on August 19, 2021:
*Allergies/Health Concerns/Special Needs: (If none, please state none)
*Guardian 1 FIRST Name:
*Guardian 1 LAST Name:
*Guardian 1 Birthdate:
*Guardian 1 Email address:
*Guardian 1 Mobile Number:
*Guardian 1 Relationship to Child:
Guardian 2 FIRST Name:
Guardian 2 LAST Name:
Guardian 2 Birthdate:
Guardian 2 Email address:
Guardian 2 Mobile Phone:
Guardian 2 Relationship to Child:
*Child's School:
*Dismissal Instructions

All children 3 months through 4th Grade will NOT be released from class without the presentation of the security tag issued at check-in upon arrival.  Parents, guardians, or middle school age and above siblings may pick up children K-4th grade with the security tag.  5th graders may be dismissed at the completion of The Galaxy to meet their family in a designated location.  If you would prefer your 5th grader remain in the Zone until pick up, please indicate by stating No-Remain below.   Selecting Yes-Dismiss below means that your 5th grader will be released.
*Consent To Treat

In the event my child has a medical emergency and I am unable to be reached, Memorial Drive Presbyterian Church may obtain medical treatment for my child
*Photo/Video Release

Memorial Dive Presbyterian Church may use my child's name or picture in photos and/or video in promotional materials and /or on the MDPC website regarding MDPC.
Questions/Comments for Children's Ministry?
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