BLAST Kids Sign Up

BLAST Kids Registration

* Indicates required field

Parent/ Guardian Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Emergency Contact and number if you cannot be reached *

Child's Name *

First

Last

Grade *

Child's Birthday *

Child's Name *

First

Last

Grade *

Child's birthday *

Child's Name *

First

Last

Grade *

Child's Birthday *

Do any of the above children have any allergies? *

I hereby give my permission for all the children listed to attend BLAST and ride in the Forestburg Baptist Church vans for activities and to allow my child to picked up from the school on Wednesday afternoons and any other special evets thru the year. I understand that my child(ren) will be under adult supervision at all times. I understand and release and hold harmless Forestburg Baptist Church, its trustees, officers, employees, and any volunteers from liability, past, or future, fully and completely. I authorize the executive staff or designated medical professional to administer emergency medical assistance if I cannot be reached. *

I give my permission for my child's image, to be printed and/or posted on a website or social media network page associated with this church/organization. *

Parent Name and Date *

Submit

BLAST Kids Information and Registration

BLAST Kids Registration

Location

Telephone

Email