pastor@halstedroadbaptist.org
(815) 964-6216
June 25-29th, 2018 | 11am-2pm | @Halsted Road Baptist Church, 3326 Halsted Rd, Rockford, IL 61101
Your Name (required)
Your Email (required)
Family Name (ie, "Griffin"
Child's First Name
Child's Last Name
Child's Age (4-11yo)
Child's Sex ---malefemale
Emergency Contact Number (required)
Note: Allergies, Special Needs, etc