BLAST Family Registration Form Please enable JavaScript in your browser to complete this form.Parent's Information - Step 1 of 3Please complete this form to register your child for the 2023 BLAST program. Parent/Guardian 1 *FirstLastMobile *Email *Would you like to register another parent? *NoYesParent/Guardian 2 *FirstLastMobileEmailAddress *Address Line 1Address Line 2CityState / Province / RegionPostal CodeHow many children are you registering? *12345NextChild 1Name *Date of Birth *DD12345678910111213141516171819202122232425262728293031MM123456789101112YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Grade *Kinder (4 years old)Prep12345Allergies/Medical Conditions/Special NeedsChild 2Name *Date of Birth *DD12345678910111213141516171819202122232425262728293031MM123456789101112YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Grade *Kinder (4 years old)Prep12345Allergies/Medical Conditions/Special NeedsChild 3Name *Date of Birth *DD12345678910111213141516171819202122232425262728293031MM123456789101112YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Grade *Kinder (4 years old)Prep12345Allergies/Medical Conditions/Special NeedsChild 4Name *Date of Birth *DD12345678910111213141516171819202122232425262728293031MM123456789101112YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Grade *Kinder (4 years old)Prep12345Allergies/Medical Conditions/Special NeedsChild 5Name *Date of Birth *DD12345678910111213141516171819202122232425262728293031MM123456789101112YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Grade *Kinder (4 years old)Prep12345Allergies/Medical Conditions/Special NeedsPreviousNextDo you give permission for Mitcham Baptist Church BLAST to take and use photos of my child/children for the purpose of its own ministries? *NoYesName of Parent or Guardian *I (as above) give Mitcham Baptist Church BLAST permission to take and use photos of my child/children for the purpose of its own ministries.Do you give permission for your child's/children's names to be published alongside the photograph? *NoYesI am aware the Mitcham Baptist Church will use my photos in good judgment and as agreed to by me and that I have the right to revoke permission for use at any time. Signature *Clear SignatureGDPR Agreement *I consent to having this website securely store my submitted information according to the General Data Protection Regulation. This information will not be shared, sold or made public and is solely used for the purposes of running this ministry. For more information please refer to our privacy policy at MBC Privacy Policy.We appreciate your co-operation in assisting us with these contact details. The information is required so that we can place your children into an age appropriate program and also to communicate with you regarding the BLAST program. Below are our details, so please feel welcome to drop us and email or give us a call should you have any questions or concerns. Thank you for your co-operation Blessings Ann Fanner 0418 361 263 or [email protected] PreviousSubmit Registration