Kids BLAST Registration 2023-2024

Parent/Guardian Information

Please provide contact info for parent(s)

Your contact information will be used by Atonement's staff and leaders to communicate with you, including Atonement’s mailing list.

Atonement will not give your personal information to any third parties.

Parent/Guardian Name

Parent/Guardian Email

Parent/Guardian Phone Number

Phone Number is:

Mobile Number Home Number Work Number

Home Address

Parent/Guardian Name

Parent/Guardian Phone

Phone Number is: Mobile Number Home Number Work Number

Parent/Guardian Address (if different than other parent's address)

Children Information

Please provide contact info for your child(ren)

Contact information will be used by Atonement's staff and leaders to communicate with you, including Atonement’s mailing list.

Atonement will not give your personal information to any third parties.

Child 1

Child's Name

Date of Birth

School

Grade

Graduation Year (from High School)

Does the child have any allergies?

Does the child have any medical issues that we should know about?

Child 2

Child's Name

Date of Birth

School

Grade

Graduation Year (from High School)

Does the child have any allergies?

Does the child have any medical issues that we should know about?

Child 3

Child's Name

Date of Birth

School

Grade

Graduation Year (from High School)

Does the child have any allergies?

Does the child have any medical issues that we should know about?

Child 4

Child's Name

Date of Birth

School

Grade

Graduation Year (from High School)

Does the child have any allergies?

Does the child have any medical issues that we should know about?

Child 5

Child's Name

Date of Birth

School

Grade

Graduation Year (from High School)

Does the child have any allergies?

Does the child have any medical issues that we should know about?

**Please sign (type name below) to indicate you agree to allow permission for Atonement Lutheran Church to use your child’s picture for advertising/promoting events.

Any Additional Comments

Description

Please register your child(ren) for BLAST in the 2023-24 program year.

Kids BLAST Registration 2023-2024

Description

Please Fix the Following