Bible Blast Registration

Bible BLAST Registration 2019-20 School Year

Please fill out the form below to register your child for Bible BLAST. Note that those entries with a * are required. Bible Blast is on Wednesdays from 9-10 a.m. Students will be picked up at ShES at 9:00 a.m. and taken to Grace Church at 473 Plank Rd. They will return to school at 10:00 a.m. For more information, contact us at bibleblast@graceshrewsbury.com

Student's Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Date of Birth*
Name of Parent(s) or Guardian(s)*
First Last
Parent Email*
Home Phone
Parent Cell Phone*
Work Phone
Emergency Contact Name*
First Last
Emergency Contact Phone*
Child's Doctor's Name*
First Last
Child's Doctor's Phone
Allergies - Please list medication and food allergies here or write none.*
Does your child have any other HEALTH ISSUES or SPECIAL LEARNING NEEDS you would like us to be aware of?
Home Church (if any)
How did you learn about Bible BLAST?
I give permission for my child to participate in Bible BLAST each week.*
- I understand my child will be driven to Grace Church at 473 Plank Rd. (by van, bus or personal vehicle when needed).
- I give permission to Bible BLAST to use photos that may include my child online or for publicity purposes (no names used).
- I give permission to the Bible BLAST staff to act on my behalf in my child's best interest in the event of an accident or emergency, while making immediate attempts to contact me.
- I would like more information about the Bible BLAST program. Please contact me.
Online Parent Signature for consent of the above check boxes.*