J-ROCK 2024 Registration Form
Please complete the form below for all students you would like to register.

There is a $75 Registration Fee per camper required to complete your registration. This can be paid via CashApp ($Cornerstone1988) or by contacting the office at 215-724-6858 to pay by credit card.

Please contact our office if you have any questions.
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Email *
Child's First Name *
Child's Last Name *
What is your child's major area of interest? Please select only one (1). *
Child's Age *
Child's Birthday *
MM
/
DD
/
YYYY
Select child's t-shirt size *
Is your child currently enrolled at Cornerstone Christian Academy? *
Child's Current Grade as of June 2024 *
Does your child have any allergies? *
If yes, please list any allergies.
Emergency Contact Name *
Emergency Contact Phone Number *
Emergency Contact Email Address *
Parent/Guardian first name *
Parent/Guardian last name *
Parent/Guardian phone number
Parent/Guardian email address
Street Address
City
State
Zip
Do you want to register any additional children? *
Select Yes *ONLY* if additional children have the same Parent/Guardian and Emergency Contact information.
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