Mommy & Me 2011 Registration

REMINDER: MOMMY & ME IS IN LAUREL THIS YEAR

Child's Information
Child's Name (list all)	Age (Years)






Do any of the children listed above have any medical conditions that would interfere with their participation in the camp?
Please list all allergies or medications for your child:
Name of Doctor

Parent/Guardian Contact
Parent/Guardian Name
Home Phone
Cell Phone
Email

Parent/Guardian Address
Home Address
City
Zip Code

Person Responsible for Pickup
Name
Phone

Emergency Contact
Name (other than Parent/Guardian)
Phone

Church Information
Do you regularly attend a church?
Name of Church

Please write in any questions or comments you have about Mommy & Me here:

Medical Waiver and Photo Release Form
By submitting this form, I hereby release The Rock Church, Laurel, Montana, and its short-term mission teams from any and all claims of liability, personal injury or property damage arising from participation in this Sports Camp. I understand that participation in sports involves some element of physical contact and I certify that my child is in good health and able to participate in all activities.	If any attention is required for illness or injury, I give my permission to a Sports Camp staff member for such care. I give consent for my child to be photographed or videotaped during the cam pand release use of the images by The Rock Church for similar sports camp and mission related promotional purposes.
Type your name here to affirm >>>

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The Rock Church is a growing community of believers that is dedicated to building the kingdom of God and spreading the message of Jesus Christ to the people of Laurel, Montana. We would like to extend to you a special invitation to join us for a wonderful time of worship and celebration this Sunday at The Rock Church.

The Rock Church | 820 West 9th Street | Laurel, Montana | 59044

Phone: (406) 628-6200
Email: info@therockmt.com

Mommy & Me 2011 Registration

REMINDER: MOMMY & ME IS IN LAUREL THIS YEAR

Child's Information

Parent/Guardian Contact

Parent/Guardian Address

Person Responsible for Pickup

Emergency Contact

Church Information

Medical Waiver and Photo Release Form

Type your name here to affirm >>>

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