Cancer Support Group

Family Registration

Thank you for filling this form out as completely as possible, even if you are updating information we already have. Your child's safety and well-being are incredibly important to us.

Mother's Name*
First Last
Mother's Date of Birth*
Mother's Home Phone
Cell Phone*
Father's Name*
First Last
Father's Date of Birth*
Home Phone
Cell Phone*
Family's Address*
Street Address Address Line 2 City State ZIP Code
Main Email Address*
Enter Email Confirm Email
Secondary Email Address
Enter Email Confirm Email
Children*
First Name Last Name Date of Birth Grade School Name Email
Known Allergies (all children)*
Special Instructions (all children)*
Emergency Contact*
Please list two people who can serve as an emergency contact if a parent is not available.
Name Phone
Emergency Contact*
Name Phone
Emergency Medical Information*
Pediatrician Phone Number Preferred Hospital
Comments
This field is for validation purposes and should be left unchanged.

Serve Our Mountain and City

Tell Us About Yourself

Serve at LMPC: Volunteer Opportunities

General Information

Food/Beverage/Linens

A/V Equipment

Facility Use Rules & Regulations

Introduction

Rules and Regulations

Chapel (125)
Choir Room (60)
Church Office Lobby (12)
Conference Room (85)
Courtyard
E-200
E-201
E-202
E-203
E-204
E-300 A
E-300 B
E-300 Combined
E-301
Elementary Classroom Area
Fellowship Hall (348)
Fellowship Hall Lobby
Fellowship Hall Stage
Flower Room
Kitchen
Library
Little Narthex
Main Parking Lot
Memorial Garden
N-100 Baby Chicks
N-101 Loving Lambs
N-102 Tiny Tugboats
N-103 Cuddly Caterpillars
N-104 Puddle Jumpers
N-105 Joyful Giraffes
Narthex
Nursery Office
Pastor's Office (outside Upper Room)
Pastor Hitching's Office
Pastor Middlebrooks's Office
Pastor Nettleton's Office
Pastor Salter's Office
Playground
Porte-cochere
Reception Room (65)
Sanctuary (400)
Small Conference Room (12)
Upper Room

First Name	Last Name	Date of Birth	Grade	School Name	Email

Pediatrician	Phone Number	Preferred Hospital

Cancer Support Group

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