Sunday Kaleidoscope (Special Needs) Registration

*Address Line 1
Address Line 2
*City
*State/Province/Region
*Zip/Postal Code
A separate form should be filled out for each child attending Kaleidoscope Sunday School. 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 Birthdate:
*Age on August 19, 2020:
*Grade for School Year 2020-2021:
*Name of School Child Attends:
*Child's Gender:
Are you interested in main-streaming your child?:
*Main Streaming:
*Time Options::
Allergies/Health Concerns/Special Needs:
Father's Name: Last, First:
Mother's Name: Last, First:
I understand that children will not be released from Kaleidoscope Ministry without the presentation of the security tag issued at the time of check-in each Sunday.:
*I Understand the Security Tag requirement:
In the event that 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:
*Is child toilet trained?:
I understand that if my child is over the age of 4, the Kaleidoscope Ministry Director will contact me if he/she requires a diaper change.:
I understand:
Other Questions/Comments for Children's Ministry?:
Submit Form