2019 Buddy Break Pre-Registration Form
Please complete this form if you intent to reserve a spot for your VIP child at the Hope International Buddy Break location. Your reservation is confirmed once you complete this form and are contacted by a Buddy Break Team member confirming space availability. You will receive a call or text from the Buddy Break phone line (352) 405-6163. We look forward to seeing you soon!
Saturday, April 27 from 10:00 A.M. - 1:00 P.M. at Hope International Church. Address is 13806 State Road 33, Groveland, FL 34736.
Name of Parent or Guardian *
Your answer
How Many VIP Children Will Be Attending Buddy Break?
Your answer
VIP Child's Name(s) *
Your answer
Ages of VIP Child or Children *
Your answer
What Type of Special Needs or Overall Diagnosis Does the VIP Child or Children Have? *
Your answer
Best Phone Number To Reach You To Confirm Your Reservation at Buddy Break *
Your answer
Email *
Your answer
Will Siblings attend Buddy Break? *
How many Siblings will attend Buddy Break?
Your answer
Names and Ages of Siblings
Your answer
Have you attended Buddy Break previously at another location? *
Have you attended Buddy Break at Hope International previously? *
Have you participated in the Buddy Break Orientation at another Buddy Break location? *
It is a requirement for all VIP families to experience the VIP Orientation for Buddy Break. If you have not participated previously, we will give you the VIP Orientation on your first attendance to our Hope International Buddy Break.
Have you participated in the Buddy Break Orientation at Hope International previously? *
Are you a member or regularly attend church? If yes, where do you attend church?
Your answer
Please confirm that you understand that completing this form is your intent to reserve a spot for your VIP child at the Hope International Buddy Break location. Your reservation is confirmed once you complete this form and are contacted by a Buddy Break Team Member confirming space availability. You will receive a call or text from the Buddy Break phone line (352) 405-6163.
After receiving a call or text from the Buddy Break phone line confirming your reservation space, if you decide that you can not attend or need to cancel, please agree that you will contact Buddy Break to cancel your reservation so that your space can become available for another VIP child. *
Required
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