Cornerstone’s Kids Membership

First name

Last name

Name of Parent or Guardian

Mailing Address (Required to receive Welcome Packet)

Email

Phone

T-Shirt Size

Birth Date

Is this child grieving the loss of a loved one?
YesNo

If yes, would the child like to receive a sympathy card in the mail each year?
YesNo

If yes, what month did the child experience their loss?
—Please choose an option—JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember