MYC — Lighthouse Baptist Church

moms of young children (MYC)

Name

First Name

Last Name

Address

Phone Number

(###)

###

####

Email Address

Preferred Method of Contact

Email

Text

Phone Call

Emergency Contact

Name and Phone Number

Have you previously attended MYC?

Yes

No

What is the name of the church you currently attend?

Only if applicable

Children's Name and Date of Birth

First Name mm-dd-yy

Do you or any of your children have any food/medical allergies? Any other information that would be helpful in placing your child in a class?