REGISTER NOW for Cornerstone Church Cheshire's SUMMER BLAST for kids ages 6-12

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Registration Form - ****PLEASE COMPLETE ONE FORM FOR EACH CHILD

SUMMER BLAST is August 12, 13, 14 from 9:00 AM - 12:30 PM @ Cornerstone Church, 1146 Waterbury Rd., Cheshire

Email *

Child's First Name *

Child's Last Name *

Parent/Guardian Name *

Street Address *

City *

Zip *

Mailing Address (if different) Street, City, Zip

Home Phone Number *

Cell Phone Number *

Age Information *

YYYY

Last grade completed in school *

MEDICAL INFO / ALLERGY INFO

Medical Information-Please list medical information we need to know & any ALLERGIES below. *

Emergency Contact #1: Name & Phone number *

Emergency Contact #2: Name & Phone number *

Dismissal Information-Please name who may pick up your child at the end of Summer Blast *

Other Information: (Please check if "yes")

Does Your Child attend Sunday School?

May we have permission to photograph your child?

May we have permission to use your child's photograph for the purpose of promotion?

Is your child visiting our church?

If visiting, who are you a guest of?

Name?

Any additional information we need to know?

A copy of your responses will be emailed to the address you provided.

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