Sunday Elementary Registration

*Address Line 1
Address Line 2
*City
*State/Province/Region
*Zip/Postal Code
A separate form should be filled out for each child (three months through 5th grade) enrolling MDPC Children's Ministry. In the fields above, please indicate the Child's Name along with the preferred email, home address and phone number for your family.:
*Name child goes by:
*Child's Gender:
*Child's Birthdate:
*Age on August 19, 2021:
*Grade for 2021-2022 School Year:
*Name of Child's School:
Allergies/Health Concerns/Special Needs:
Father's Name: Last, First:
*Mother's Name: Last, First:
Serve Options:
Kindergarten through 4th graders will not be released from The Galaxy without the presentation of the security tag issued at check-in upon arrival each Sunday. 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 to remain in the Zone until pick up, please indicate by stating Yes or No below. ("Yes"-they may be dismissed or "No" - they must remain in the Zone.):
*Dismissal Instructions:
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.:
*I agree with the Treatment Release:
Memorial Drive 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.:
*I agree with the Photo/Video Release:
Other Questions/Comments for Children's Ministry?:
Thanks for registering! If you wish to register someone else, please complete another form after clicking "Submit Form" below.
Submit Form