Registration Form for Children's Ministry Programs

Child's Information

Home & Contact Information

Pickup Information - Name(s) of Person(s) Authorized to Pick Up Child

(Optional) Notify me of updates and upcoming events via:

Consent, Medical, Liability & Media Release

I grant the following consents to Long Meadow Chapel (LMC), its staff and its volunteers for the student named on this form. Permission to participate in any on-site children’s ministry or church event including but not limited to discipleship training, children’s church, Bible Discovery and Kid’s Club. Permission to secure medical treatment for my child in case of emergency. (Parents will be notified as soon as possible using the contact information on this form. The student’s medical policy will be the primary policy covering any medical event.) Furthermore, I release LMC, its staff and its volunteers from any liability in the event of an accident, injury or sickness not directly resulting from gross negligence.

These additional initialed optional consents are also granted:

Medical Information

Please list any allergies, medications, medical conditions, emotional challenges or physical concerns staff should be aware of when working with your student for his/her safety and the safety of others. Leave blank if there are none