Middle School Dodgeball Night

Pop, chips, dodgeball & friends!

DATE & TIME:
Friday, April 17th 7-8:30 pm

Hope Covenant Church
(336 4th Ave. S, St. Cloud)

Contact olivia@hopecovenant.org with any questions.

Parent/Guardian Information

Parent/Guardian Name

This address will receive a confirmation email

Phone

Address

Student #1

Student #1 Name

Student #1 Grade

Please select one option.

6th 7th 8th

Student #1 Allergies/Medical Conditions/Special Needs

Student #2

Student #2 Name

Student #2 Grade

Please select one option.

6th 7th 8th

Student #2 Allergies/Medical Conditions/Special Needs

Student #3

Student #3 Name

Student #3 Grade

Please select one option.

6th 7th 8th

Student #3 Allergies/Medical Conditions/Special Needs:

Student #4

Student #4 Name

Student #4 Grade

Please select one option.

6th 7th 8th

Child #4 Allergies/Medical Conditions/Special Needs

Emergency Contact & Photo Release

Who should we contact in the event of an emergency? (Name)

Emergency contact phone number.

I understand and authorize that my child’s image may be photographed or filmed and used in Hope Covenant Church video presentations, printed publications, Web site and on social media.

Please select one option.

Yes No

Parent/Guardian Signature (type name):

By providing a telephone number and submitting the form you are consenting to be contacted by SMS text message from Hope Covenant Church Via Breeze Church Management software (Breezechms.com). Message frequency may vary. Message & data rates may apply. Reply STOP to opt out of further messaging. Reply HELP for more information. See our Privacy Policy.

Middle School Dodgeball Night

Description

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