Stepping Stones Registration

Child's First & Last Name

Birth Date (mm/dd/yyyy)

Age/Grade

Parent/Guardian Names

Street Address

City

Home Phone

Alternate Phone

Your Email

Emergency Contact and Phone

Known food allergies or other medical concerns

Do you have a church home?
yesno

If yes, name

Is your child baptized?
yesno

In case of emergency, I give my permission for any necessary medical treatment to be given to my child. I will not hold The Rock or any leader/staff persons responsible for any injury that may occur.

I hereby give my permission for photos/video to be taken of my child during Stepping Stones to be used in or on the following: local newspapers, church brochures, promotional materials, The Rock's website, The Rock's worship services. It is understood that names of individual children may be present in various published items.

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