Little People Ministry Registration Form

Child's Information

Parties Authorized to pick up child from LPM or in case of emergency

Parent Guidelines

I have received and read the Guidelines brochure and I am willing to abide by the terms stated within. I grant permission for the staff to screen my child before entering the LPM room. I am aware that this is a first come first serve ministry for Sunday participation.

In case of Emergency

If my child should become ill or injured at LPM, I understand that LPM staff will:
1. Contact me immediately
2. If I cannot be reached, contact the persons I have designated above.
3. Should LPM be unable to rech me and/or persons designated above, they are authorized to contact 911 or arrange for emergency treatment. I will be responsible for payment of medical services rendered.

Permission to release photographs and/or video