Cornerstone Baptist Church, Ida, MI, - Ministries

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Please fill in all form fields. ( if the answer to any question does not apply or you do not have an answer for it simply type NA or none.

Name of Child:		Age:
Street Address		City: State: Zip:
Home Telephone		Cell Phone:
Home Email Address:		Date of Birth
Grade child will enter in Fall:

In case of an Emergency Contact:
Name:		Phone #

Allergies or other Medical Conditions

Home Church:
Name of Special friend your child might like to be with:
Who is authorized to pick up your child: