Bricks 4 Kids Socialization Event Registration Form
Student's Full Name
Date of Birth
Home Telephone Number
Parent's Full Name
Address (if different from above)
Home Telephone (if different from above)
Emergency Contact Information
Please select the date in which you would like to register for this event
January 16, 2018 from 6:30 - 8:00 pm at Millbridge
February 16, 2018 from 6:30 - 8:00 pm at DMS
March 13, 2018 from 6:30 - 8:00 pm at DIS
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