Teen Impact Event-Tuesday, December 10th

Adult name:

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Email

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This address will receive a confirmation email

Family Info

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Foster Adoptive Kinship Guardianship Other

Name of Agency (if applicable)

Phone

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Address

*

Please provide the following information for all children that will be attending. Please include your children's FIRST and LAST name. All information is required to register your child in childcare.

Child's full name:

Birthdate: Ex. (00/00/0000)

Grade:

Specific instructions for child:

Child's full name:

Birthdate: Ex. (00/00/0000)

Grade:

Specific instructions for child:

Child's full name:

Birthdate: Ex. (00/00/0000)

Grade:

Specific instructions for child:

Child's full name:

Birthdate: Ex. (00/00/0000)

Grade:

Specific instructions for child:

Child's full name:

Birthdate: Ex. (00/00/0000)

Grade:

Specific instructions for child:

Child's full name:

Birthdate: Ex. (00/00/0000)

Grade:

Specific instructions for child:

Child's full name:

Birthdate: Ex. (00/00/0000)

Grade:

Specific instructions for child:

Permission: I give permission for my child/children to be cared for by Fostering Connections volunteers. Please type YES if you are planning for your kids to attend this event.

*

Thank you! We look forward to seeing you there!

Description

Countryside Christian Church 6:00-8:00 p.m.

Please fill out this form and click submit.