Lighthouse Missionary Church
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Health form
*
Indicates required field
Child's name
*
First
Last
Nickname
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
age
*
gender
*
grade
*
Family Phone Number
*
Child's Mobile Number
*
Child's Email
*
Health history
Please complete the following. The information provided will be used at all youth related activities in conjunction with Lighthouse Missionary Church, including: youth group, quiz meets, camps, retreats, and other outings.
Allergies
*
Please list any allergies your child may have: including foods, insects, medications, seasonal, etc. Include a description of the reaction and how it is managed. If your child has no known allergies, please write NKA. Thank you!
Chronic Concerns
*
Does your child have any health concerns, disabilities, injuries? Such as Asthma, Anxiety, Depression, Diabetes, Headaches, Seizures, Menstrual cramps, Fainting, Frequent Colds, etc. If your child has no health concerns please write none that we know of.
Date and month of your child's last Tetanus Booster:
*
Submit
Home
Covid-19
About us
Staff
History
Missions
Sermons
Lynn's Devotional
WHAT'S HAPPENING
LMC Calendar
Children's Church Schedules
Keryx Calendar
LMC Newsletter
Soul Care
MORE
Contact Us
Prayer page
>
Prayer Chapel
Volunteer Survey
Nomination Survey
Health Form
Local Conference
General Conference Notes 2019
Scholarship Applications
