Include any medical conditions (MC), allergies (AG), medication or custody orders (CO).
Please add all additional members of your household.
Include in Medical Notes any medical conditions (MC), allergies (AG), medication or custody orders (CO).
The data collected on this form by LifeHouse International will be stored safely within Planning Center Online servers. It can only be accessed by authorised Staff and Department leaders and is used for the purpose of caring for and communicating with you and your family, in particular, in the case of an emergency and will not be disclosed to any other parties other than by legal obligation.
By selecting Yes, you agree to us storing your information in our system.