Children's Ministries Registration 2023-24

Welcome to Mount Bethel Church's Children's Ministries Registration! We are so excited to participate in your family's spiritual development. Sunday School for the 2023-2024 school year will begin Sunday, September 10. Club/Journey/Base Camp/Junior Choir will begin Wednesday, September 13. Please provide the requested information for your child below, even if he/she does not plan on beginning in September because of other extracurricular commitments. All information should be pertinent to this coming academic year.

Feel free to call the church office if you have any questions (570-897-7142).

Child's First and Last Name

Gender

Grade

School

Teacher (Homeroom Teacher)

Birthdate (MM/DD/YYYY)

Address

Children's Ministry Participation (select all that apply)

Children's Church (PreK – 2nd grade) Sunday School (PreK – 6th) Club 119:11 (K – 3rd) Journey 45 (4th – 5th) Base Camp (6th) Junior Choir (2nd – 6th)

If you do not plan on beginning some/all of the programs in September, please let us know your anticipated start-date for each program here.

Please list any siblings (first and last names) also participating in the children's ministries. You will still need to complete a separate registration for each child.

Contact Information

Parent/Guardian 1 First and Last Name

Parent/Guardian 1 Cell Phone [to receive text messages]

Parent/Guardian 1 Email

This address will receive a confirmation email

Parent/Guardian 2 First and Last Name

Parent/Guardian 2 Phone

Parent/Guardian 2 Email

Pick Up Information

Who will be picking up your child most frequently?

Are there any pick-up restrictions for your child?

If there are pick-up restrictions, please describe them.

Emergency Information
In the event of an emergency during our midweek programs, we will always call 911 first. Please tell us who you would like us to call first following our call to 911 (even if this is you). This should be the person most able to receive texts and/or calls during the Wednesday afternoon program hours.

Emergency contact name

Emergency contact number

Emergency contact relationship

Medical Information

Does child take any medication on a regular basis?

Yes No

Name of medication

What is the medication for?

Does your child have an IEP?

Yes No

If your child has an IEP, please include diagnosis/reason and explain.

Are there any special conditions about which your child's teacher should be made aware? e.g. physical, mental, emotional conditions, fears (thunderstorms, animals).

If so, how should we respond or treat this condition?

Allergy Information

Any allergies?

Yes No

Types of allergies

Allergy instructions (please be specific)

Does child carry an EPI Pen?

Yes No

Transportation Permission

Students are provided transportation to Mount Bethel Church from the Bangor Area Schools for Club 119:11, Journey 45 and Base Camp. By affixing your initials and entering your full name below, you are agreeing to give permission for your child registered above to ride the provided transportation to Mount Bethel Church on Wednesdays, beginning September 13, 2023, to attend Club 119:11, Journey 45 and/or Base Camp. In the event your child is absent from school or will not be participating for any reason, you must notify the church so the child's name can be removed from the weekly transportation pick-up list. If you do not notify the church prior to 1pm we are required to pick up your child. (Note: In addition to this signature, there will also be a hard copy transportation form that must be printed, completed, and submitted to both the school and the church following the completion of this registration form.)

Parent/guardian initials

Parent/guardian full name

Date

Media Permission

I hereby grant Mount Bethel Church the right to obtain and/or use my child's photograph, digitized image, video and/or voice recording for educational and informational purposes.

Yes No

Church Information

Does your family currently attend Mount Bethel Church? Yes No

Current church attending

Would you like more information about participating in the ministries of Mount Bethel Church? Yes No

Fee Schedule for Club 119:11/Journey 45/Base Camp

The fee for the Wednesday after school programming is $50 per child ($100 for a family maximum). These monies help offset the cost of transportation, snack and supplies for the year. Please know that it is never our intention that these fees should be a financial hardship. We want all children to participate in these life-changing programs regardless of their financial means! There are scholarships available, if you would like more information please email Susan Battillo. Thank you again, and we look forward to seeing you soon. (Remember to click "submit" below to complete the registration.)

Payment

Payments will be made online, if you need to make other arrangements please email Susan Batillo.

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Children's Ministries Registration 2023-24

Description

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