Student Ministry Student Ministry theMIX Registration 2016-2017 CORE Registration 2016-2017 Middle School About The Mix High School About CORE Profession of Faith The Process Fundraising Opportunities Childcare Application Childcare Submission Form Childcare Pay Scale Snow Removal Childcare Application First name Last name Street address City State Zip code Phone Email address Please list two references, name and phone number. Grade Senior Junior Sophomore Freshman 8th 7th 6th Please check all days that you are available/willing to provide childcare. Sunday Monday Tuesday Wednesday Thursday Friday Saturday Are you available/willing to drive to provide childcare? (ie. Oskaloosa, Montezuma) yes no Please refer to the pay scale, then agree to the terms below. All payment received from this service will be applied to the student's mission trip fund. If the student decides not to participate in a mission trip, the payment from the services provided will be forfeited. Yes, I agree to the terms of payment. Students are responsible for filling out the Childcare Submission form online after each service provided. If forms are not filled out within the week, payment is forfeited. I agree to filling out a weekly form online and agree to the terms of payment. I give permission for my student to participate in the childcare services for ministries (Groups, Revere, Healing Service) at Third Church. I acknowledge that my student will forfeit payment if he/she decides not to go on a mission trip, or does not turn in the required paperwork online. I hereby release Third Church, it’s staff and volunteers, from any and all liability. I, as the parent or guardian, agree to these terms. Additional comments or questions.