Christus Victor

Making Christ Known

We are an Evangelical Lutheran Church of America (ELCA) congregation growing in the likeness of Christ by:

Worshiping, praying, and studying God’s word;
Being together with other people; and
Acting in faith through words and deeds both inside and outside our church walls.

2017-18 MOPPET REGISTRATION FORM

Please fill out one form per child

Mother's Name *
Mother's Name
Child's Name *
Child's Name
Child's Birthday *
Child's Birthday
Emergency Contact 1 *
Emergency Contact 1
Who has permission to pick up this child in case of an emergency? (Please list 2 contacts)
Phone Number 1 *
Phone Number 1
Please list the phone number of your first emergency contact.
Emergency Contact 2 *
Emergency Contact 2
Who has permission to pick up this child in case of an emergency? (Please list 2 contacts)
Phone Number 2 *
Phone Number 2
What is the phone number of your 2nd emergency contact?
Please list the name and age of each sibling of this little MOPPET.
What is your MOPPET'S favorite toy, song, and games?
Does your MOPPET have any allergies? If so, please list them.
Are there any special needs or specific instructions we should know about your MOPPET?