Child's Information

full name (required):

birthdate (required):

gender: -- select gender -- male female

current grade (required):

class (required): -- select class -- KIDS Praise KIDS Rock

child's email address:

please alert us to any medical conditions, allergies or diets (required):

Release

I hereby give Red Mountain Community Church the right to record photographs and video footage of my child and to use, re-use, publish and re-publish in whole, or in part for any purpose, including, but not limited to illustration, training or promotion. I hereby release and discharge Red Mountain Community church from any and all claims, and demands arising out ofor inconjunction with the use of the images.

By entering my name, email address and today's date in the fields below, I am in effect electronically signing this release.

full name (required):

email address (required):

today's date (required):

Adult(s) Child Lives With

Please note: You only need to complete this section if you are new to RMCC or if your information has changed.

full name:

cell phone:

email address:

relationship to child: -- select one -- father mother step-dad step-mom grandparent

full name:

cell phone:

email address:

relationship to child: -- select one -- father mother step-dad step-mom grandparent

address:

city state zip:

home phone: