Come Join the Race!
June 23-27, 2025 6PM to 8PM Crossview Community Church - 510 N. Piedmont Ave. Rockmart, GA 30153
Child's Name
*
First Name
Last Name
Gender
Please Select
Male
Female
Prefer not to state
Parent / Guardian Name
*
First Name
Last Name
Last Grade in school COMPLETED
*
Please Select
Completed K
Completed 1st
Completed 2nd
Completed 3rd
Completed 4th
Completed 5th
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent / Guardian Phone Number
*
Parent / Guardian E-mail
example@example.com
Please list the names of those adults (18 or older) who are authorized to pickup your child at the end of the session. ID will be required.
*
Does your child have any special needs, health issues or dietary restrictions (including allergies) that we need to be aware of?
*
Please Select
Yes
No
Photos and videos will be taken throughout the event and possibly be used for social media or church program information. Please check here if you DO NOT wish your child to be included.
Do not include my child in any photo or videos during the event.
Please describe the special needs, health issues, dietary restrictions or allergies we should be aware of.
*
Submit
Should be Empty: