2025 Halloween Bash Family Registration Form

School Bash 2025 | Please fill out this form and click submit.

Name

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Name-2

Phone

*

Phone #2

Address

*

Email

*

This address will receive a confirmation email

1-Name of Sick Child/Person

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Age-1

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1-B/G

*

Please select one option.

Boy Girl

Date of Birth

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Month & Year Diagnosed

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Name of Cancer

*

Current Treatments. Please update us as to current treatments. If none-say none. Sees the dr. how many times a week or month. This will go into your chart. Thank you

*

Other Minor Kids 1st Name Only

2-Child

2-Age

2 -B/G

Please select one option.

Boy Girl

DOB-2

3-Child

3-Age

3-B/G

Please select one option.

Boy Girl

3-DOB

Child 4

4-Age

4-B/G

Please select one option.

Boy Girl

4- DOB

Child 5

5-Age

5-B/G

Please select one option.

Boy Girl

5-DOB

Child 6

6-Age

6-B/G

Please select all that apply.

Boy Girl

6-DOB

Child 7

7-Age

7-B/G

Please select all that apply.

Boy Girl

7-DOB

Child 8

8-Age

8-B/G

Please select one option.

Boy Girl

8-DOB

Any other Minor Children. List Name-Age-Date of Birth

Emergency Contact Person

*

Cell Phone

*

Date

*

I /We do hereby release my/our story and my/our picture(s) to ADONAI, Inc. to be used to promote the success stories of ADONAI, Inc., its services and the successful support it provides to families in our community. Pictures & stories may be used in posters, newsletters, internet website, etc. I/We also acknowledge there shall be no financial or otherwise compensation paid, implied, guaranteed or suggested to you and/or your family, business or employer.

*

Description

School Bash 2025

Please fill out this form and click submit.

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