R.O.C.K.S. Registration Card The information collected by this form is used to enroll and identify kids, participating in ROCKS, at Tyro Christian Church. Age*Please enter a number from 4 to 12.Please enter the age your child will be, as of May 28th (ages 4 and up).Grade going into:*Pre-KKindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th GradePlease select the grade your child will be going into, this coming school year.Child's Name* First Last Please enter your child's first and last name.Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Please enter the address where your child resides.Does your child have any medical conditions or allergies?*YesNoPlease select "Yes" or "No" Medical Condition / Allergy informationIf you selected "yes" above, please provide as much detail about the Medical Condition and/or Allergy as you feel is necessary for us to adequately care for your child.Has your child attended ROCKS in prior years?*YesNoParent's/Guardian's Name* First Last Please enter the first and last name of the above mentioned child's parent or legal guardian.Email* Enter Email Confirm Email Please enter the email address of the above mentioned child's parent or legal guardian.Add'l Parent's/Guardian's Name First Last Please enter the first and last name of the above mentioned child's parent or legal guardian.Primary Phone*Please enter the phone number for the first listed parent/guardian.Secondary PhonePlease enter the phone number for the second listed parent/guardian.Emergency Phone*Please enter an emergency contact number.Home Church/CityPlease provide the name and city of your home church (Exp. Tyro Christian Church / Tyro) Home Church Attendence*NoneTwice AnnuallySemi-MonthlyEvery WeekPlease provide the regularity of your family's church attendance. Drop-Off/Pick-Up & Bus Schedule* Irregular Schedule/Situation (Please provide details, below) Parent Drop-Off Bus Rider Parent Pick-Up Please select the Transportation needs of the above listed child. Choose all that apply.Irregular Schedule/SituationIf you selected "Irregular Schedule/Situation" above, please provide as much detail about the Schedule/Situation as you feel is necessary for us to adequately care for your child.