Lihue Missionary Church - LMC Kids Ministry Registration Form

LMC Kids Ministry Registration Form

Child's Information

First Name

Last Name

Gender

Birthdate

Grade

Parent/Guardian 1 Information

First Name

Last Name

Relationship to Child

Phone Number

Email

Parent/Guardian 2 Information (if applicable)

First Name

Last Name

Relationship to Child

Phone Number

Email

Emergency Contact (if different)

First Name

Last Name

Phone Number

Medical & Special Information

Allergies (food, medication, etc.)

Medical conditions, special needs, behavioral concerns, etc.

My child may have snacks offered in class

Yes

No

Pick-Up Authorization

Who is authorized to pick up your child? (adults only)

Nursery Only

If my child needs a diaper change:

Text me/Come get me

Nursery worker may change it

I give my permission for my child to:

Participate in LMC Kids Ministry activities.

Receive first aid if necessary.

Be photographed for church use on website, social media, promo materials, etc. (No personal info will be shared)

Signature

Date Input