Information Form - Pulpit Rock Church in Colorado Springs

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- The List
- RightNow Media
Events
Media
- Sermons
- Podcast: Welcome to the Table
Give

Info Form

Fill out this form to be added to our contact list. This is the best way to stay informed about all that is happening at Pulpit Rock Church. We'll be in touch as soon as you hit submit!

Step 1 of 2 - General Information

50%

I am a(n):*
- Individual
- Family
Your Name*
First Last
Gender*
- Male
- Female
Name of spouse/significant other
First Last
If you are filling out this form as a family
Gender
- Male
- Female
Home Address*
Street Address Address Line 2 City State ZIP Code
Phone number*
What is the best number to reach you?
Email address (primary for family)*
Enter Email Confirm Email

What is the best email address to reach you?
Photo release/consent
- Yes
Pulpit Rock Church may record/photograph events, services, and other church-related activities. By checking "Yes," you are consenting to allowing PRC to use this media for promotional purposes.

Do you have any children age 18 or under?*
- Yes
- No
If you have any children older than 18, please have them fill out a separate form.
1st Child's Information
1st child's name
Date of birth*
Gender*
- Male
- Female
Allergy/Special Needs/Medical Alerts
Please let us know if this child has any allergy needs, special needs, or medical alerts we need to know about.
Current grade
School
I have a second child to register.
- Yes
- No
Student Information
Student's email address
Best phone number for student
Student's shirt size
2nd Child's Name
2nd Child's Information
Date of birth*
Gender*
- Male
- Female
Allergy/Special Needs/Medical Alerts
Please let us know if this child has any allergy needs, special needs, or medical alerts we need to know about.
Current grade
School
Student Information
Student's email address
Best phone number for student
Student's shirt size
3rd Child's Name
3rd Child's Information
Date of birth*
Gender*
- Male
- Female
Allergy/Special Needs/Medical Alerts
Please let us know if this child has any allergy needs, special needs, or medical alerts we need to know about.
Current grade
School
Student Information
Student's email address
Best phone number for student
Student's shirt size
4th child's name
4th Child's Information
Date of birth*
Gender*
- Male
- Female
Allergy/Special Needs/Medical Alerts
Please let us know if this child has any allergy needs, special needs, or medical alerts we need to know about.
Current grade
School
Student Information
Student's email address
Best phone number for student
Student's shirt size
5th Child's Name
5th Child's Information
Date of birth*
Gender*
- Male
- Female
Allergy/Special Needs/Medical Alerts
Please let us know if this child has any allergy needs, special needs, or medical alerts we need to know about.
Current grade
School
Student Information
Student's email address
Best phone number for student
Student's shirt size
6th child's name
6th Child's Information
Date of birth*
Gender*
- Male
- Female
Allergy/Special Needs/Medical Alerts
Please let us know if this child has any allergy needs, special needs, or medical alerts we need to know about.
Current grade
School
Student Information
Student's email address
Best phone number for student
Student's shirt size
7th child's name
7th Child's Information
Date of birth*
Gender*
- Male
- Female
Allergy/Special Needs/Medical Alerts
Please let us know if this child has any allergy needs, special needs, or medical alerts we need to know about.
Current grade
School
Student Information
Student's email address
Best phone number for student
Student's shirt size
8th Child's Name
8th Child's Information
Date of birth*
Gender*
- Male
- Female
Allergy/Special Needs/Medical Alerts
Please let us know if this child has any allergy needs, special needs, or medical alerts we need to know about.
Current grade
School
Student Information
Student's email address
Best phone number for student
Student's shirt size
If you are registering your child for Kid's Ministry, this is the end of the pre-registration form. You will need to complete the final registration at the Kid's Ministry Registration area at the East Entrance. At the final registration you will be asked to:
- Sign a medical release
- Choose a place to serve in your child's program
- Fill out a volunteer application form
You will receive an email with this information as well.
I would like more info on...

Sundays 9:00 AM & 10:30 AM
301 Austin Bluffs Parkway, Colorado Springs, CO 80918
(719) 598-6767

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