Register for the Lifeline Mass
Date and Time: Nov 3, 2018, 3-10PM
Address: Departs 2621 McMenemy St, Little Canada, MN 55117
Contact us at (651)288-3272 or
Email address *
Adults attending - Name(s) *
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Would you like to be a chaperone? (Safe Environment/E3 Qualification necessary) *
Teens you are attending with - Name(s) and Grade(s) *
Note: For all youth, the Permission Slip at needs to be filled out and turned in to Joe Block at
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Comments, Notes, Questions, or Feedback?
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