Name

Date Of Birth

Age

Parent's Names

Parent's Phone Numbers

Mailing Address

Town / State / Zip

Emergency Contact Person #1

Emergency Contact Person #1 Cell

Emergency Contact Person #2

Emergency Contact Person #2 Cell

E-mail (for updates/reminders)

Allergies (including food)

Would you like to receive emails for serving with us at future Community events? Would you like to receive emails for serving with us at future Community events? Yes No

Do you give permission for Cornerstone Church to take pictures of your child and potentially use them for promotional material and/or church media projects? Do you give permission for Cornerstone Church to take pictures of your child and potentially use them for promotional material and/or church media projects? Yes No

Do you have any additional comments or requests about this registration?