Midland Evangelical Free Church logo

Midland Evangelical

Free Church

Worship @ 9:00 & 10:45 AM

The Portal

Child Pre-Enrollment

CHILD PRE-ENROLLMENT

BLAST Ministries Logo

Welcome to Midland Free, we are excited to have you join us on Sunday! Please fill out the below information for your family. This information will be asked of you at the Guest Check-In station if it is not submitted ahead of time here. 

and * denote required fields. All other fields are optional but will assist us in connecting your family at Midland Free.

If you submit the information after Friday at noon you may experience a delay on Sunday morning for enrollment. Thank you for your time and attention!

Our Wonderfully Enabled ministry is available to work with children who have additional needs. If your child could use a one-on-one shadow please fill out our Children with Special Considerations Intake Form. A link will be provided upon the completion of this pre-enrollment form as well.

Please indicate who is filling out the form:






FAMILY INFORMATION
*Family Last Name:
*Country:
Address Line 1:
Address Line 2:
Home Phone:
*City:
State:
*Zip:
*How did you hear about Midland Free?:
If Applicable from above, who connected you with Midland Free?:


HEAD OF HOUSEHOLD #1 
Parent/Guardian

*Prefix:
*First Name:
Middle Name:
*Last Name:
Nickname:
Suffix:
*Email:
Cell Phone:
*Gender:
Marital Status:
*Birthdate:


HEAD OF HOUSEHOLD #2 
Parent/Guardian

There is a 2nd adult Head of Household in the home:
If there is not a 2nd adult Head of Household, please skip this section and go to the Household Member #3 section.
Are Head of Household 1 and Head of Household 2 married to each other?:
* Prefix:
* First Name:
Middle Name:
* Last Name:
Nickname:
Suffix:
Email:
Cell Phone:
* Gender:
Marital Status:
* Birthdate:


HOUSEHOLD MEMBER #3 
Child or Other Adult

There is a 3rd Household Member:
* Household Position:
* Prefix:
* First Name:
Middle Name:
* Last Name:
Nickname:
Suffix:
Email:
Cell Phone:
* Gender:
Marital Status:
* Birthdate:
* Grade:
* If this is a child, do they have an allergy or medical condition?:
If yes, please indicate what the allergy or medical condition is:
* If yes, is this a life threatening allergy or medical condition?:
If the individual has a life threatening allergy or medical condition please complete the Life Threatening Allergy & Medical Condition form. Please print this form and bring it with you on Sunday.


HOUSEHOLD MEMBER #4 
Child or Other Adult

There is a 4th Household Member:
* Household Position:
If there is not a 4th household member please skip the following sections and submit the form at the bottom of the page.
* Prefix:
* First Name:
Middle Name:
* Last Name:
Nickname:
Suffix:
Email:
Cell Phone:
* Gender:
Marital Status:
* Birthdate:
* Grade:
* If this is a child, do they have an allergy or medical condition?:
If yes, please indicate what the allergy or medical condition is:
* If yes, is this a life threatening allergy or medical condition?:
If the individual has a life threatening allergy or medical condition please complete the Life Threatening Allergy & Medical Condition form. Please print this form and bring it with you on Sunday.


HOUSEHOLD MEMBER #5 
Child or Other Adult

There is a 5th Household Member:
If there is not a 5th household member please skip the following sections and submit the form at the bottom of the page.
* Household Position:
* Prefix:
* First Name:
Middle Name:
* Last Name:
Nickname:
Suffix:
Email:
Cell Phone:
* Gender:
Marital Status:
* Birthdate:
* Grade:
* If this is a child, do they have an allergy or medical condition?:
If yes, please indicate what the allergy or medical condition is:
* If yes, is this a life threatening allergy or medical condition?:
If the individual has a life threatening allergy or medical condition please complete the Life Threatening Allergy & Medical Condition form. Please print this form and bring it with you on Sunday.


HOUSEHOLD MEMBER #6 
Child or Other Adult

There is a 6th Household Member:
* Household Position:
* Prefix:
* First Name:
Middle Name:
* Last Name:
Nickname:
Suffix:
Email:
Cell Phone:
* Gender:
Marital Status:
* Birthdate:
* Grade:
* If this is a child, do they have an allergy or medical condition?:
If yes, please indicate what the allergy or medical condition is:
* If yes, is this a life threatening allergy or medical condition?:
If the individual has a life threatening allergy or medical condition please complete the Life Threatening Allergy & Medical Condition form. Please print this form and bring it with you on Sunday.


HOUSEHOLD MEMBER #7 
Child or Other Adult

There is a 7th Household Member:
* Household Position:
If there is not a 7th household member please skip the following sections and submit the form at the bottom of the page.
* Prefix:
* First Name:
Middle Name:
* Last Name:
Nickname:
Suffix:
Email:
Cell Phone:
* Gender:
Marital Status:
* Birthdate:
* Grade:
* If this is a child, do they have an allergy or medical condition?:
If yes, please indicate what the allergy or medical condition is:
* If yes, is this a life threatening allergy or medical condition?:
If the individual has a life threatening allergy or medical condition please complete the Life Threatening Allergy & Medical Condition form. Please print this form and bring it with you on Sunday.


HOUSEHOLD MEMBER #8 
Child or Other Adult

There is a 8th Household Member:
If there is not a 8th household member please skip the following sections and submit the form at the bottom of the page.
* Household Position:
* Prefix:
* First Name:
Middle Name:
* Last Name:
Nickname:
Suffix:
Email:
Cell Phone:
* Gender:
Marital Status:
* Birthdate:
* Grade:
* If this is a child, do they have an allergy or medical condition?:
If yes, please indicate what the allergy or medical condition is:
* If yes, is this a life threatening allergy or medical condition?:
If the individual has a life threatening allergy or medical condition please complete the Life Threatening Allergy & Medical Condition form. Please print this form and bring it with you on Sunday.



Thank you for completing this form! Click "Submit Form" below to finish your enrollment process.

If you have any questions about this form, please contact JoDee Phillips, our Special Programs & Activities Coordinator, at jodeephillips@mefchurch.org