Children’s Ministry Registration

Full Name

Date of Birth

Age

Grade

Allergies

Does your child have any physical or psychological conditions that would restrict his/her participation in activities?

Yes No

If yes, please explain in detail.

Mom's Name

Mom's Cell Phone

Dad's Name

Dad's Cell

Email address you would like us to use to contact you:

Authorized person(s) to pick up my child when necessary

Authorized Person Name

Authorized Person Phone

Authorized Person Name

Authorized Person Phone

Are you expericing any of the following symptoms listed below? (If so, please check all that apply)

Yes No

Have you recently tested positive for COVID-19?

Yes No

Have you recently been exposed to anyone who have tested positive for COVID-19?

Yes No

Please attest below that you understand the above statement and have provided accurate and true information with a signature and date. Thank You.

**Mount Calvary International Worship Center requires all partners/visitors towear a face mask when inside the building.Since we are taking the appropriate safety measures for indoor worship services, MCIWC will not be held responsible for anyone who may contract COVID-19.

Ways to Give

Right Here On Website

Text To Give

text amount to 504-470-0059

Homeless Outreach Registration