2018-2019 Sunday Night BLAST!
Sundays September 9 -May 5, 5:30-7PM | Please complete this form and submit! Thank you!
Child's Name
*
Birthdate
*
Curent school grade:
*
Please select one option.
pre-k
Kindergarten
1st
2nd
3rd
4th
5th
Select Option
pre-k
Kindergarten
1st
2nd
3rd
4th
5th
School child attends:
Parent/Guardian's Name
*
Address
*
--
AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Cell Phone
*
Email
*
This address will receive a confirmation email
Emergency Contact Name
*
Emergency Contact Phone
*
Other adults my child may go home with:
Allergies/Medical Concerns
T-Shirt Size
*
Please select one option.
Small
Medium
Large
Adult Small
Does TCBC have permission to use photos/videos of my child for promotional purposes?
*
Please select all that apply.
Yes
No
Do you authorize staff/volunteers of TCBC to treat or seek medical treatment in the event of an emergency?
*
Please select all that apply.
Yes
No
Please let us know how you heard about the BLAST program.
*
Please select one option.
Social Media
Flyer in child's school
Friend/Family member
Attended VBS this summer
Attended BLAST last year
I am a TCBC member
Banner
Other
Select Option
Social Media
Flyer in child's school
Friend/Family member
Attended VBS this summer
Attended BLAST last year
I am a TCBC member
Banner
Other
Do you/your family currently have a church home?
*
Please select all that apply.
Yes
No
If so, please share with us where you attend church:
Submit
Description
Sundays September 9 -May 5, 5:30-7PM
Please complete this form and submit! Thank you!
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