B.L.A.S.T. 2023

Child's Name

Child's Age

Child's Gender

Birthday

Parents/Guardians

Phone

This address will receive a confirmation email

Mailing Address

Preferred Method of Contact

Emergency Contact Information

Emergency Contact

Emergency Contact Relationship to Child

Emergency Contact Phone

Allergies/Other Medical Concerns We Should Know About

Additional Information

Home Church

Grade for 2023-2024 School Year

What School Will Your Child Be Attending?

If anyone other than you will be picking up your child, please list their names:

From time to time we like to take pictures and videos to post on our website and social media pages. I hereby grant Roebuck Baptist Church permission to use photographs of the child indicated in this form for their webiste, social media pages, and other publications without further consideration.

Yes, I grant permission No, I decline to grant permission

Print/Sign Name

Date

Description

June 19th - 22nd || 9:30-2:30

Please fill out this form and click submit.

B.L.A.S.T. 2023

Description

Please Fix the Following