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MOPPETS Registration

Please provide the following contact information, fill one out for each child attending the program:

Last Name/First Name
Birthday
Address
City, State, Zip
Home Phone
Cell Phone
Email
Father's Name (if applicable)

Who has permission to pick up your child in an emergency?

Name/Phone
Name/Phone
Pediatrician
Pediatrician Phone
Pediatrician Address
Allergies
Additional Emergency Contact Name/Phone

Sibling 1 (Name and Birthday)
Sibling 2 (Name and Birthday)
Sibling 3 (Name and Birthday)
Sibling 4 (Name and Birthday)
Favorite Food, Toys, Games, Songs
Special Instructions
Verification

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Helpful Information
Sundays
Prayer: 9:15 am - 9:45 am
Celebration Service 10:00 am

During Service...
- K.I.D.S. Church (Ages 6-12)
- Wee Worship (Ages 3-5)
- Nursery (Birth-Age 2)
Tuesdays
Ignite Student Minstries (Jr./Sr. High) 6:00 pm - 9:00 pm

Wednesdays
Abundant Life Service 6:30 p.m.
Royal Rangers/MPact Girls Club
6:30 pm - 8:00 pm
Nursery Available
Newsletter Signup

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