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iBlast/iGnite Registration
Register to attend the Fall 2019 sessions beginning October 1st.
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* Indicates required question
Child's Full name
*
Your answer
Child's Age
*
Your answer
Birth Date
*
MM
/
DD
/
YYYY
Boy/Girl
*
Boy
Girl
Current Grade Level
*
Pre-K (iBlast)
Kindergarten (iBlast)
1st (iBlast)
2nd (iBlast)
3rd (iBlast)
4th (iBlast)
5th (iBlast)
6th (iGnite)
7th (iGnite)
8th (iGnite)
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
Yes
No
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