Broken Faith: Broken Lives

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
Email
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

Broken Faith: Broken Lives

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