WinterBlast 2020

March 6, 2020 | Please fill out this form and click submit.

Event Timing: March 6-7th, 2020 from 6:30 p.m to 7:00 a.m.

Event Location: Sager Creek Community Church, Lokomotion, and JBU.

Event Pricing: 1 Student $35, 2 Students $60, 3 Students $85

Contact us at 479-524-3577

Parent/Guardian Name

*

Parent Phone

*

Student 1 Name (First and Last)

*

Student 1 Gender

*

Please select all that apply.

Male Female

Student 1 Grade

*

Please select all that apply.

5th 6th 7th 8th

Does your student attend a youth group, if so which one?

*

Student 2 Name (First and Last)

Student 2 Gender

Please select all that apply.

Male Female

Student 2 Grade

Please select all that apply.

5th 6th 7th 8th

Student 3 Name (First and Last)

Student 3 Gender

Please select all that apply.

Male Female

Student 3 Grade

Please select all that apply.

5th 6th 7th 8th

To pay with cash or check select cash/check from the drop down menu. If you are paying with cash/check you can drop off your payment at the church office (1010 S Maxwell St), give it to Nathan Nall on Sunday mornings, or pay the night of the event. Please make checks payable to Sager Creek Community Church.

Payment

1 Student ($35) 2 Students ($60) 3 Students ($85) Pay with cash or check ($0)

Amount

Email

*

This address will receive a confirmation email

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

March 6, 2020

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