B.L.A.S.T. Registration
When: Wednesdays, November 4-March 17
Time: 6:00-7:30pm
Event Address: 404 S. Duncan Rd. Champaign, 61821
Contact us at (217) 378-5278 or unitybaptchamp@sbcglobal.net
Child's Name *
Parent's Name *
Address *
Phone Number *
Child's age (as of September 1) *
Child's Grade *
Please list any food allergies or restrictions: *
Emergency Contact(s) Name and Phone Number *
Child's Doctor and Hospital *
Please list the names and phone numbers of persons authorized to pick up your child: *
I wish for my child to wear a mask at all times unless eating or playing at game time *
I give Unity Baptist Church consent to use photos and/or videos of my child for church use including but not limited to: bulletin boards, newsletters, bulletin inserts, slideshows, church website, and social media. (We will never identify your child in any way on our website or social media) *
I understand that I will have to pay $10 upon arrival *
Required
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