Parent's Day OutName *Date of Birth *Age *Parents' Names *Parents' Phone #'s *Mailing Address *Town *State *Zip *Emergency Contact Person #1 *Emergency Contact Person #1 cell *Emergency Contact Person #2 Emergency Contact Person #2 cell Allergies (including food)E-mail *(for updates / reminders)Would you like to receive email for serving with us at future Community events? *YesNoDo you give permission for Cornerstone Church to take pictures of your child and potentially use them for promotional materials and/or church media projects? *YesNo VerificationPlease enter any two digits *Example: 12This box is for spam protection - <strong>please leave it blank</strong>:
