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Father's Name
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Occupation & Employer
Mother's Name
First Last
Occupation & Employer
Address
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Phone
Church Affiliation if applicable
Children in your family
Please list names and ages and whether or not you are requesting a scholarship for that child.
Child's Name Age Scholarship requested?
Is your family receiving financial aid from any other institution?
- Yes
Please indicate the name of the institution/program and the family member(s) receiving aid.
Family Member Institution/Program
Please explain in detail why you feel you need scholarship assistance for Mother's Day Out.
Please specify monthly amount you think you would be able to pay.
We can't guarantee this amount but this helps us in the selection process.

This is a WAITLIST only. You will be contacted if space opens up.*
- Yes, I understand
Child's Name*
First Last
Child's Date of Birth*
MM slash DD slash YYYY
Name of Parent/Legal Guardian 1*
First Last
Name of Parent/Legal Guardian 2
First Last
Family Mailing Address*
Street Address Address Line 2 City State ZIP Code
Preferred Family Email*
Preferred Contact*
First Last
Preferred Contact Phone Number*
Church Affiliation (Optional)
How did you hear about us?*
Comments
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Name(Required)

First Last

Email(Required)

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Would you like to receive the weekly LMPC news email?(Required)

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Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

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As God provides, I plan to give the following amount for January 1, 2024 – December 31, 2024:*
Name*
Email*
Address*
Street Address Address Line 2 City State ZIP Code
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Phone
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Thank you for filling this form out as completely as possible, even if you are updating information we already have. Your child’s safety and well-being are incredibly important to us.

"*" indicates required fields

Mother's Name*

First Last

Mother's Date of Birth*

Mother's Home Phone

Cell Phone*

Father's Name*

First Last

Father's Date of Birth*

Home Phone

Cell Phone*

Family's Address*

Street Address Address Line 2 City State ZIP Code

Main Email Address*

Enter Email Confirm Email

Secondary Email Address

Enter Email Confirm Email

Children*

First Name

Last Name

Date of Birth

Grade

School Name

Email

Allergies?*

Known Allergies (all children)

Special Instructions (all children)

Photo Permissions

Do we have permission to use your child(ren)’s image in LMPC media (website, publications, social media)? No names will be used.

Yes

No

Emergency Contact*

Please list two people who can serve as an emergency contact if a parent is not available.

Name

Phone

Emergency Contact*

Name

Phone

Emergency Medical Information*

Pediatrician

Phone Number

Preferred Hospital

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Phone

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Email*

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Email(Required)

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Who Can Get Married at LMPC?

In accordance with the wedding policy approved by the Session, those who fall into one of the following categories are welcome to request the use of the church facilities for their wedding:

LMPC members
LMPC associate members (students or temporary residents who maintain their primary membership with a home church but have joined LMPC as associate members)
children of LMPC members
young adults* who were active and regular participants in the youth ministry
college students* who
- attend LMPC regularly
- and participate regularly in at least one church ministry
LMPC-supported missionaries
children of LMPC-supported missionaries

*An LMPC pastoral recommendation confirming the involvement of the applicant is required in order to begin the application process.

Tacky Bowling: We don our tackiest outfits, head to SpareTime, and split into groups for some fun and fellowship. Cost is determined annually.
Create Your Own Quest: The youth staff turns the main LMPC building into a series of adventures that each group of students must work together to conquer.
Girl/Guy Retreat: This event is an overnight retreat at the church. The girls have fellowship, meals, devotional times, and sleep overnight at the JHYB, while the guys do the same at the main building. Cost is determined annually.
Wells Fargo: Held at the Commons, Wells Fargo is a “team sports” type of event encouraging fellowship and loyalty to one’s team.
Missions Week: Usually in mid-June, this week is LMPC’s VBS week, and the students serve their younger brothers and sisters in the elementary department during this week of fun, fellowship, and mentoring.
Camp Kulaqua: Located in Florida, Camp Kulaqua is a highlight of our year. We join youth from other churches to worship, hear a featured speaker, play team games, and engage in a wide range of activities available at the camp. Cost is determined annually.
Ice Cream Olympics: Our event to welcome the rising 6th graders, Ice Cream Olympics is a messy and fun event in which we break into teams and use ice cream in the games. After getting hosed off post-Olympics, we partake of frozen treats, and students hear about our ministry philosophy and programs.
The Green Bean Game: This favorite event of the year, “The Green Bean Game Recon Thing” gets its name from the coveted cans of green beans hidden in the church building. The student teams are tasked with finding the hidden cans, but they cannot be caught by the co-directors while they search the dark building.
Fall Retreat: An overnight retreat from Friday night to Sunday at noon, the fall retreat is at a nearby camp and is a time of building relationships – with Jesus and with fellow students and leaders. Cost determined annually.
Progressive Dinner: Our Christmas event in early December, the progressive dinner moves between the JHYB and main building. Parents assist in preparing appetizers and desserts, and we cater the main course. The students sing carols, play games, and hear Christ-centered messages from youth leaders. Cost is determined annually.

Salt & Light with Ski trip: An in-town retreat, Salt & Light begins on the Wednesday of the week the students return to school and ends on Sunday night. There is a featured speaker, an early morning breakfast, times of worship and reflection. For the past few years, the retreat has also included an out-of-town day ski trip on Saturday. There is no cost for the in-town portion, but there is a cost for the ski trip.
Ponderosa: An out-of-town weekend retreat from Friday night until Sunday at noon, usually in February, Ponderosa Bible Camp is a perfect location to hang out with friends, strengthen relationships and hear from our oldest students. Cost is determined annually.
Girl/Guy Retreat: Usually an out-of-town weekend event, the separate girls and guys retreats encourage gospel-rich conversations, fellowship, and discipleship. Cost is determined annually.
Missions Week: We serve some of LMPC’s strategic partners during a week in June. Helping Widows Harvest and Church of the First Born makes for a great missions week for our students. Cost is determined annually.
Beach Trip: Usually the first week in July, the high school ministry spends a week on Hilton Head Island enjoying fellowship on the beach during the day and having a conference-style time at night at Hilton Head Presbyterian Church. With a featured speaker, a time of worship, and a shared dinner meal, each night is full of Gospel-rich conversations. Cost is determined annually.
Rafting: As the event to welcome the rising 9th graders, our rafting trip down the Ocoee is preceded by lunch together and a sharing of our vision for high school ministry. Cost is determined annually.
Fall Retreat: An overnight retreat from Friday night to Sunday at noon, the fall retreat is at a nearby camp and is a time of building relationships – with Jesus and with fellow students and leaders. Cost is determined annually.
Progressive Dinner: Our Christmas event in early December, the Progressive Dinner moves between homes and the JHYB. Parents assist in preparing appetizers and desserts, and we cater the main course. The students sing carols, play games, and hear Christ-centered messages from youth leaders. Cost is determined annually.

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