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Kidz Rock Registration
We are so glad that your child will be joining us for Kidz Rock on Wednesdays! Please fill out the form below to get them registered!
Child's Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Age *
Your answer
Child's Current Grade *
Parent/ Guardian Name *
Your answer
Parent Phone number *
Your answer
Address *
Your answer
City *
Your answer
Email *
Your answer
Emergency Contact NAME (must be different than parent name) *
Your answer
Emergency Contact PHONE NUMBER (must be different than parent number) *
Your answer
Do you need transportation to/ from church on Wednesday nights? (Trenton area) *
Required
Any Health/ Allergy Issues?
Your answer
Name of person who invited you or who you have visited The Rock with
Your answer
In the event of an emergency, I give permission to The Rock of Trenton and its leaders/volunteers to secure the proper medical treatment for my child. In the event that I cannot be reached, I give permission to the physician selected by The Rock to order x-rays, routine tests, and treat. I the undersigned do hereby verify that the information above is correct, and I do hereby release and forever discharge all sponsors and The Rock of Trenton from any and all claims, demands, actions, or cause of action, past, present, and or future arising out of any damage or injury while participating in activities sponsored by The Rock of Trenton. *
Electronic Signature * I understand that typing my name constitutes a legal signature confirming that warrant the truthfulness of the information provided on this form is correct. Please type parent/guardian name responsible below. *
Your answer
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