Child's Name

Email Address

Birthdate

Street address

Suburb

Parent(s)_name(s)

In case of emergency, contact

Allergies or other medical conditions

Phone number

School year just completed

Name of home church, if any

Do you grant permission for Cornerstone Baptist Church to use pictures of your child for informational and promotional purposes? Do you grant permission for Cornerstone Baptist Church to use pictures of your child for informational and promotional purposes? Yes No

Parent/legal guardian

By submitting you agree that all your information is correct.