HCC Disability Ministry Respite Night Registration Form - Families
Friday, January 24, 2025 | 6pm-8:30pm | WELCOME TO RESPITE NIGHT!
Please fill out this form for EACH PERSON who will participate in the event.
The cell phone you provide will be the one we will use if we need to contact you during the event.
If you have multiple children to register, the confirmation page has a button to take you back to the form.
Name of Child
*
Birthdate
*
Grade
Gender
*
Please select one option.
Male
Female
Parent Name
*
Parent Email
*
This address will receive a confirmation email
Parent Cell Phone
*
Allergies
Does your child have disabilities? If yes, please describe below.
Please select all that apply.
Yes
No
Disability
Is there anything specific we need to know about your child to make this event enjoyable??
Submit
Description
Friday, January 24, 2025 | 6pm-8:30pm
WELCOME TO RESPITE NIGHT!
Please fill out this form for EACH PERSON who will participate in the event.
The cell phone you provide will be the one we will use if we need to contact you during the event.
If you have multiple children to register, the confirmation page has a button to take you back to the form.
×
Please Fix the Following