1. 763-477-6300; 763-477-7092 (fax); www.ourfatherschurch.org
Insurance Waiver
Our Father’s Lutheran Church Mothers of Preschoolers (OFLC MOPS) does not provide any type of heath or accident insurance from injuries incurred by you in the MOPS program or your child in the MOPPETS program.
Please sign and return the information below indicating you already have adequate insurance for your family and child(ren) enrolled in the OFLC MOPPETS Program.
MOPPETS (including school age children who may attend on non-school days):
First Name _____________________ Last Name ________________ Date of Birth ________
We have adequate insurance to protect our family in case of an accident.
Parent’s/Teacher’s Signature ___________________________________________ Date _______________________
Our Father’s Lutheran Church, 3903 Gilbert Avenue Southeast, Rockford, Minnesota 55373
; (fax);

2. Photography Waiver
Many times during the year we have occasion to take pictures of children. These photos may be used for bulletin boards, scrapbooks, flyers and other publications.
In addition, local newspapers may ask to take photos of children for their publications. We also take Polaroid’s digital images and videos of special events.
It is the policy of OFLC MOPS that individual names will not be associated with any picture on the website.
_____Yes, I give my permission for my child(ren)____________________________, to be included in all photographic images that my be taken for MOPS/MOPPETS related activities including but not limited to: newspapers, television, slide presentations, scrapbooks, brochures, church/MOPS website and MOPS videos.
I realize that if any time during the year I wish to deny my permission, It will be my responsibility to notify MOPS in writing.
____ No, I do not want my child included in MOPS/MOPPETS photos, etc.
Parent/guardian signature_______________________________ Date____________________