2019 Blast Off 2 School Registration final
Enter info for registering for 2019 Blast Off 2 School Program
AT THE END OF THIS FORM YOU MUST SCHEDULE AN APPOINTMENT TO PICK UP THE SCHOOL SUPPLIES
Parent/Guardian First Name
Parent/Guardian Last Name
Phone Number (XXX-XX-XXXX)
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
Rochester Community Schools
Avondale School District
Ethnicity (check all that apply)
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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