BLAST 3/6-3/27

BLAST will begin on Tuesday, March 6 and end on Tuesday, March 27, 2018. | Please fill out this form and click submit.

Child Name

*

Child Grade

*

Please select one option.

K 1st Grade 2nd Grade

Parent Name

*

Email

*

This address will receive a confirmation email

If your child has previously participated in programs at The Vineyard Center, and if you have no changes at all to the requested info below, please check the appropriate box. If your child has not previously attended our programs in the past, please complete all areas of this form. Thank you.

Please select all that apply.

I have no changes. All info is the same. Please use the updated information as listed below.

Address

Best Contact #

Emergency Contact Name

Emergency Contact Number

Riding Bus #81

Please select all that apply.

Yes No

Does child have any severe allergies?

Please select one option.

None Yes, Note info below

Additional Allergy Info:

I give authorizaiton to grace ridge church to photograph and release such photographs of my child for the purpose of public information and publicity in the interest of the church.

Please select all that apply.

Yes No

$10 Donation requested. Please make checks payable to "grc" or pay online. Link will be provided in confirmation email.

Description

BLAST will begin on Tuesday, March 6 and end on Tuesday, March 27, 2018.

Please fill out this form and click submit.

Please Fix the Following

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