iBlast/iGnite Registration
Register to attend the Spring 2020 sessions beginning January 14th 2020
Child's Full name *
Your answer
Child's Age *
Your answer
Birth Date *
MM
/
DD
/
YYYY
Boy/Girl *
Current Grade Level *
School My Child Attends *
Your answer
Parent or Guardian's Name *
Your answer
Home Address, City, State, Zip *
Your answer
Home Phone
Your answer
Work Phone
Your answer
Cell Phone
Your answer
Email
Your answer
Home Church
Your answer
Emergency Pick-Up #1 Name *
Your answer
Emergency Pick-Up #1 Phone *
Your answer
Emergency Pick-Up #2 Name
Your answer
Emergency Pick-Up #2 Phone
Your answer
Food Allergies/Medical Concerns (provide details)
Your answer
I give permission for my child's photo, audio or video recording to be used to promote Good News Clubs
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