2019 Blast Off 2 School Registration final
Enter info for registering for 2019 Blast Off 2 School Program
Email address *
AT THE END OF THIS FORM YOU MUST SCHEDULE AN APPOINTMENT TO PICK UP THE SCHOOL SUPPLIES
Parent/Guardian First Name *
Your answer
Parent/Guardian Last Name *
Your answer
Phone Number (XXX-XX-XXXX) *
Your answer
Are you a current Neighborhood House Client? *
Do your children qualify for medicaid or reduced lunch program *
How many children do you have who qualify for this program (Preschool through Grade 12)? *
What City do you live in? *
What school district do your children attend *
Ethnicity (check all that apply) *
Required
Primary Language *
Have you or your spouse served in the military?
Social media permission
I hereby authorize NH to use or distribute my image and/or the image of my child in photograph or video tape recordings or any visual/audio medium for publicity materials, social media, annual report, etc.
Do you authorize to take pictures of your children for social media? *
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