Sunday Nursery Registration

*Address Line 1
Address Line 2
*Zip/Postal Code
A separate form should be filled out for each child (12 weeks to 24 months) enrolling in Ark Adventures Nursery 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 Gender:
*Child's Birthdate:
Father's Name: Last, First:
*Mother's Name: Last, First :
Allergies/Health Concerns/Special Needs:
I understand that the children will not be released from the Nursery without 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:
Other Questions/Comments for Children's Ministry?: