Blaze Parent Contact information
At Blaze, we value our students and their safety! Please fill this out so that we're able to best serve them. If you fill this out by March 19th at 5:00 pm, your child will be entered into a drawing for a gift card!

Thank you for your commitment to loving our Youth at Cavanaugh!
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Parent/Guardian Information
Parent/Guardian 1 Name (First & Last):
 *
Relationship to Student:
 *
Parent/Guardian 1 Phone Number:
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Parent/Guardian 1 Email Address:
 *
Preferred Contact Method:
 *
Required
Parent/Guardian 2 Name (First & Last) (Optional):
Relationship to Student:
Parent/Guardian 2 Phone Number:
Parent/Guardian 2 Email Address:
Student Information
Student Name (First & Last):
Date of Birth (MM/DD/YYYY):
 *
MM
/
DD
/
YYYY
Grade:
 *
School Name:
 *
T-Shirt Size (for events/retreats):
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Emergency Contacts (Other than Parents/Guardians)
Emergency Contact Name:
Relationship to Student:
Emergency Contact Phone Number:
Medical & Special Considerations
Does your student have any allergies, medical conditions, or dietary restrictions?
 *
Does your student take any medications we should be aware of?
 *
Any additional information we should know to best support your student?
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