Children's Ministries Registration 2026-27

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 2026-2027 school year will begin Sunday, September 13. Club/Journey/Base Camp/Junior Choir will begin Wednesday, September 16. 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) NO FEE Sunday School (PreK – 6th) NO FEE Club 119:11 (K – 2nd) FEE Journey 34 (3rd - 4th) FEE Base Camp (5th - 6th) FEE Junior Choir (2nd – 6th) NO FEE

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

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

PICK UP INFORMATION

FOR AFTER SCHOOL PROGRAMS: In order to pick up your child, the car MUST have a name placard clearly displayed on the front dashboard. It is your responsibiltiy to ensure that all drivers picking up your child(ren) have a placard that is generated from MBC (no substitutes or hand made signs please).

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.

How many placards would you like?

1 2 3 4 Not needed - registration is for SS or Children's Church only

Transportation Permission for Bangor Area School District Students

Students are provided transportation to Mount Bethel Church from the Bangor Area Schools for Club 119:11, Journey 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 16, 2026, to attend Club 119:11, Journey 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 attendance and/or transportation pick-up list. Please reply using the link to the form you receive in the weekly text notification. For those who ride the bus, 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 is also a printed copy (see link) of the transportation form that must be 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

Printed Transportation Form

I have printed a copy at home. I need a printed copy provided to me.

Cell Phone Policy

To help ensure student safety and that proper transportation protocol is followed, students may not use cell phones to call or text parents or guardians before boarding the bus to the Wednesday afterschool program. All students signed up for school pick-up are expected to ride the bus to the church for the program, unless a parent has previously notified the staff before noon on that meeting date.

Students who bring cell phones to the afterschool program must keep them powered off or on silent and stored in their backpack during the program unless otherwise directed by a staff member.

Please initial that you have read the cell phone policy.

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

Do you consider Mount Bethel Church your church home?

Yes No

If not, where do you attend church?

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

This form is for all of our children's ministry programs, if you are registering ONLY for Junior Choice, Sunday School or Children's Church there is no fee.

If you are registering for the Wednesday after school program, there IS A FEE of $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 scholarship monies available with a small application fee [$5 per child, family max $10]. 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, there is a small convenience fee for using credit card payments. If you need to make other arrangements please email Susan Battillo.

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Children's Ministries Registration 2026-27

Description

Please Fix the Following