Discovery 2018: Middle School Registration
Discovery 2018: Middle School Registration
Student Full Name  * 
Student Preferred Name
Student Birthday (mm/dd/yyyy)  * 
Student Cell Number
Student Email
Student Mailing Address  * 
2016-2017 Grade Level  * 
Food/Medical Allergies (list n/a if not applicable)  * 
Dietary Restrictions (list n/a if not applicable)  * 
Prescription Medications (name, dosage, and instructions)
Is student LCUMC member?  * 
If not a member, did someone invite your child to come?
Your Email Address  * 
Emergency Contact Name  * 
Emergency Contact Number  * 
Emergency Contact Relationship w/ Student  * 
I understand my child must follow all Liberty Crossing policies. Failure to do so might result in my child being sent home early at my expense at the sole discretion of the youth pastor.  * 
I agree to deliver a copy of insurance card upon my child's arrival to Discovery.  * 
Your Name  * 
Total $
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