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MDPC Children's Ministry Registration 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*
PARENT INFORMATION
*PARENT/GUARDIAN 1 Birthdate:
*PARENT/GUARDIAN 1 Relationship to Child:
PARENT/GUARDIAN 2 First Name:
PARENT/GUARDIAN2 Last Name:
PARENT/GUARDIAN 2 Email Address:
PARENT/GUARDIAN 2 Mobile Number:
PARENT/GUARDIAN 2 Birthdate:
PARENT/GUARDIAN 2 Relationship to Child:
CHILD'S INFORMATION
*NAME child goes by:
*Child's Gender:
*Does your child have Allergies/Health Concerns/Special Needs: (If none, please state none)
*Child's Current School:
Questions/Comments for Children's Ministry?
*Come serve with us!  

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