Midweek Registration Form 2024-25

Midweek 2024-25 Registration Form

Please fill in the form below.
Parent Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
MomDadOther
E-mail
I give consent for Highland Park Midweek ministries to photograph my child(ren) and use that photo for printed and electronic media purposes. If my child is under 12 years old, Highland Park will not post my child's name with his/her photo without requesting seperate permission to do so.
I give my permission for my child(ren) to be photographed.I DO NOT give my permission to photograph my child(ren)
Child's Name*

First NameLast Name
MaleFemale
Date of Birth*

MonthDayYear
School Name or Home-School
Grade*
Allergy or medical condition we should be made aware*
Nursery: Infant-2yrs (One parent must be a leader)Pups (Cubbies): 3 yr- 4yr (Must be potty-trained)Sparks: K-2nd gradeDive: 3rd-6th grade
Child #2 Name

First NameLast Name
MaleFemale
Date of Birth

MonthDayYear
School Name or Home-School
Grade
Allergy or medical condition we should be made aware
Nursery: Infant-2yrs (One parent must be a leader)Pups (Cubbies): 3 yr- 4yr (Must be potty-trained)Sparks: K-2nd gradeDive: 3rd-6th grade
Child #3 Name

First NameLast Name
MaleFemale
Date of Birth

MonthDayYear
School Name or Home-School
Grade
Allergy or medical condition we should be made aware
Nursery: Infant-2yrs (One parent must be a leader)Pups (Cubbies): 3 yr- 4yr (Must be potty-trained)Sparks: K-2nd gradeDive: 3rd-6th grade
Child #4 Name

First NameLast Name
MaleFemale
Date of Birth

MonthDayYear
School Name or Home-School
Grade
Allergy or medical condition we should be made aware
Nursery: Infant-2yrs (One parent must be a leader)Pups (Cubbies): 3 yr- 4yr (Must be potty-trained)Sparks: K-2nd gradeDive: 3rd-6th grade
Midweek Costs

This year we have included the dues and handbook cost together. This means you pay $10 for each child. Child 4+ is free. Nursery is for the Midweek workers only. The cost for nursery is free for these workers. Ex- Child 1=$10, Child 2=$10, Child 3=$10, Child 4=Free Total=$30
Yearly (1-3 Children): $10 per child (4th+ child is free)*
Number of Children
Total Amount
Please make all payments the first night of Midweek or at the Highland Park Church office. Make checks payable to Highland Park Church and put "MIDWEEK" on the memo line. You may also pay online at Giving.
Signature*

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Midweek 2024-25 Registration Form

Midweek Costs