2023 Back to School Bash Registration Form

Childs Information

Name

Parent/Guardian Name

Address

This address will receive a confirmation email

Phone: Home & Cell

Age Information

Date of Birth

Last Grade Completed

Special Medical Information

Allergies/Medical Information

Home Church

Emergency Contact Information

Name(s)

Phone #(s)

Name(s) of person(s) who may pick up this child from Back to School Bash

Any special needs that the Back to School Bash team should be aware of:

Do you agree to allow photos of your child to be used in church presentation or church promotial materials?

Yes No

Description

August 5th, 2023 10:00 AM - 12:00PM, Lunch at 11:30AM

Please fill out this form and click submit.