MOPS Kids Registration Form 2022-2023

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Welcome! Please complete one form per child in your household attending MOPS Kids so we can learn about them to be able to provide a safe and comforting experience for them.

Child's First & Last Name *

Child's Birthdate

YYYY

Share any special needs or instructions MOPS Kids workers/volutneers should know about your child to support them during their time at MOPS.

Are there any allergies that MOPS Kids workers should be aware of? A gluten free cereal, bananas, and water will be served around 10:30 am for all children. *

Other Sibling Names & Ages

What are some of your child's favorite toys, songs, games, snacks, etc:

What else would you like us to know about you, your child or your family?

In case of an Emergency I hereby give permission to the medical personnel selected by the church staff to order X-rays, perform routine tests, and treat me, in the event I cannot an incapacitated in an emergency. I hereby give permission to the physician selected by the church staff to hospitalize, secure proper treatment, and order injection and/ or anesthesia and/ or surgery for myself. Write your name and the date to testify as your signature.
*

May Galesville MOPS have permission to post photographes of your child. Click all that you give permission to... *

I do not give permission to use my child's photo

I give permission to use my child's photo with Zion's newsletter and on Social Media with Galesville MOPS posts

I give permission to have my child's photo posted within Zion'd building with MOPS Kid art work etc.

Required

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