ALL ABOARD !

registration for computerized checkin for Port Mariners

Our new computerized check-in system will save you time and increase security for classrooms. The online form below takes 8-10 days to process. If you plan to visit us this coming weekend, you will need to fill out an information form at the Port Mariners

Welcome Harbor. if you have any questions, please email Holly Wylie
or call her at 949-854-7030 x419

type of registration:
NEW registrationaddress/phone change
name changefamily member change
my child/children regularly attend Port Mariners Weekend Service at:
Sat. 4:30pm Sat. 6:30pm Sun. 9am Sun. 11am
my child/children also attends:
Women's Bible Study (name)
M.O.P.S. (day)
CBS    MMO    KidsClub
home information:
home phone (with area code)
primary email
head of household :
first    middle    last
goes by (name printed on tag)
date of birth (mm/dd/yy)    gender M    F
home address
city     zip
cell phone     work phone
spouse :
first    middle    last
goes by (name printed on tag)
date of birth (mm/dd/yy)    gender M    F
home address
city     zip
cell phone     work phone
child 1 information :
first     middle     last
goes by (full name printed on tag)
date of birth (mm/dd/yy)    gender M    F

allergies

       print allergy info on nametag     keep confidential

special needs/medical information

       print special need/med info on nametag     keep confidential
child 2 information :
first     middle     last
goes by (full name printed on tag)
date of birth (mm/dd/yy)     gender M    F

allergies

       print allergy info on nametag     keep confidential

special needs/medical information

       print special needs/med info on nametag     keep confidential
child 3 information :
first     middle     last
goes by (full name printed on tag)
date of birth (mm/dd/yy)    gender M    F

allergies

       print allergy info on nametag     keep confidential

special needs/medical information

       print special needs/med info on nametag     keep confidential
child 4 information :
first     middle     last
goes by (full name printed on tag)
date of birth (mm/dd/yy)     gender M    F

allergies

       print allergy info on nametag     keep confidential

special needs/medical information

       print special needs/med info on nametag     keep confidential
comments :
I would like to receive the Mariners Kids email newsletter