Name of Parent/Guardian:*
Address:
Phone:*
-
E-mail:*
Child's Name:*
Child is Going into Grade: *
Child's Date of Birth:
 / 
 / 
Name of Child #2 :
Child #2 Going into Grade:
Child #2 Date od Birth:
 / 
 / 
Special Information: (i.e.,Allergies, Medication, Dietary Restrictions, etc.)
Emergency contact or pick up person:
Phone#:
-
Photo Release: Consent for Cornerstone Baptist to use photo or likeness for publication on website, Facebook. & other social media for church related purposes.
First Aid: Consent for the any volunteer leader at CBC to administer first aid if needed, (i.e. band-aid on a boo-boo, ice pack on a goose egg, etc.,)