Child's First & Last Name
Birth Date (mm/dd/yyyy)
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?
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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