SAVING SOULS Pre-Registration 
Sponsored by Place of Grace Campus - Rockingham, NC               www.pogcampus.com 

Registration ends on Dec. 16th at 12 pm. Registration is limited to the first 200 children*. 
Please register each child in your family separately. Every child will be registered into a drawing for one of ten FREE basketball goals. 

*Every child must be pre-registered, live in Richmond County, North Carolina, and be present with a parent/ guardian on Sunday, December 18th at the 11 am service at Place of Grace Campus to participate. 
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Email *
First Name of child (PLEASE DO NOT USE NICKNAMES) *
Last Name of child *
Parent/Guardian First Name 
(ADULT OVER AGE 18 that will be present on December 18th with child)
*
Parent/Guardian Last Name - (ADULT OVER AGE 18 that will be present on December 18th with child) *
Parent/Guardian Cell Phone Number  (format xxx-xxx-xxxx) *
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Gender of Student *
Required
Grade for the 2022 - 2023 school year *
A copy of your responses will be emailed to the address you provided.
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