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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