FaithInk Registration

    Child's First & Last Name

    Birth Date (mm/dd/yyyy)


    Parent/Guardian Names

    Street Address


    Home Phone

    Alternate Phone

    Your Email

    Emergency Contact and Phone

    Known food allergies or other medical concerns

    Do you have a church home?


    If yes, name

    Is your child baptized?


    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.

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