Morris Chapel Week Day Ministries Online Registration

Registration

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Welcome to Morris Chapel Week Day Ministries! Please provide your information below and click SUBMIT when complete. Credit Cards are NOT required or charged at this time. All enrollments are considered pending until we have reviewed your registration and posted any fees due. Applicable discounts will be applied as well.

* denotes required fields

Referral Information

How did you hear about us?*

Referral Name

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Primary Phone*

Additional Info

Emergency Contact Info (Not Contact #1 or #2)*

Health Insurance Carrier*

Contact #1

Contact #1 First Name*

Last Name *

Type*

How Can We Contact You?

Home Phone *

Work # *

Cell # *

Receive Text Message Notifications. By opting in, you agree to receive SMS messages from Morris Chapel Week Day Ministries. Standard message and data rates apply. Reply STOP to opt out

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Who is your employer?

Employer*

Employer Phone*

Employer Notes

Contact #2

Contact #2 First Name

Last Name

Type*

How can we contact you?

Home Phone *

Work # *

Cell # * Receive Text Message Notifications. By opting in, you agree to receive SMS messages from Morris Chapel Week Day Ministries. Standard message and data rates apply. Reply STOP to opt out

Email* (Emails are kept confidential)

Confirm Email*

Who is your employer?

Employer*

Employer Phone*

Employer Notes

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Disabilities*

Special Needs*

Allergies*

Medications*

Primary Doctor*

Immunization Notes*

Choose any filter to begin viewing available classes.

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Disabilities*

Special Needs*

Allergies*

Medications*

Primary Doctor*

Immunization Notes*

Choose any filter to begin viewing available classes.

Enroll in Classes

Select Class *

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Disabilities*

Special Needs*

Allergies*

Medications*

Primary Doctor*

Immunization Notes*

Choose any filter to begin viewing available classes.

Enroll in Classes

Select Class *

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Disabilities*

Special Needs*

Allergies*

Medications*

Primary Doctor*

Immunization Notes*

Choose any filter to begin viewing available classes.

Enroll in Classes

Select Class *

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Disabilities*

Special Needs*

Allergies*

Medications*

Primary Doctor*

Immunization Notes*

Choose any filter to begin viewing available classes.

Enroll in Classes

Select Class *

Add Another Student

Required Policies and Agreements

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Parent Handbook

I've read the above and agree.

Consent to Transport

I've read the above and agree.

Photo Consent

I've read the above and agree.

I Agree to All of the Above

Enter your Full Name* January 15, 2025

Questions or Concerns

Comments

Payment Information

Account Information

e-Payment Schedule

Credit Card

Card Number

Exp Month

Exp Year

Card Nickname

Name as it appears on card

Address Line 1

Address Line 2

City

State

Zip

Registration

Referral Information

Family Information

Where do you live?

Additional Info

Contact #1

How Can We Contact You?

Portal Access (your email is your login)

Who is your employer?

Contact #2

How can we contact you?

Who is your employer?

Student #1

Additional Info

Enroll in Classes

Student #2 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #3 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #4 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #5 (Show-Hide Details)

Additional Info

Enroll in Classes

Required Policies and Agreements (Show-Hide Details)

I Agree to All of the Above

Questions or Concerns

Payment Information

Account Information

Credit Card

Required Policies and Agreements

(Show-Hide Details)