Christmas at Rock Prairie Application

Deadline November 8th | Please fill out this form and click submit.

If you have any further questions feel free to contact Marcie at mharpel@rockprairie.net

Name

Currently Employed

Please select one option.

Yes No

Address

Phone

Text

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Yes No

This address will receive a confirmation email

What is the best time of the day to reach you?

Please select one option.

Morning Afternoon Evening

Spouse or LIve-in

Currently Employed

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Yes No

Phone

Text

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Yes No

Are you receiving Christmas gifts

Please select one option.

Yes No

Name of the group or organization

Child #1

Gender

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Male Female

Age

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1 or under 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

Child #2

Gender

Please select one option.

Male Female

Age

Please select one option.

1 and under 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

Child #3

Gender

Please select one option.

Male Female

Age

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1 and under 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

Child #4

Gender

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Male Female

Age

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1 and under 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

Child #5

Gender

Please select one option.

Male Female

Age

Please select one option.

1 and under 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

Child #6

Gender

Please select one option.

Male Female

Age

Please select one option.

1 and under 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

I affirm that I understand that I must be available on one of the two dates the church assigns for dinner and shopping. If I am not, I forfeit all rights to the program.

Typing your name here states that you agree with the above statement.

As soon as the dates are decided we will let you know in plenty of notice so you can plan for it. We will also have childcare available for these dates during the time that you are gone for dinner and shopping.

Description

Deadline November 8th

Please fill out this form and click submit.

If you have any further questions feel free to contact Marcie at mharpel@rockprairie.net

Christmas at Rock Prairie Application

Description

Please Fix the Following