Registration Form
Buddy Break is a FREE respite care program for families of children with special needs (our VIPs). North Highlands Baptist Church offers Buddy Break one evening a month from 5:30-8:30. VIPs (ages 2 through high school) and their siblings (ages 2-5th grade) are paired one-on-one with buddies and participate in activities such as games, music, story time, crafts, and more! We are currently taking reservations for the next Buddy Break. For more info, call the church office at 205-491-7921. Spring Dates : January 12, February 16, March 15, April 12, May 10
Registration request for Buddy Break at North Highlands Baptist Church
I am ready to make a reservation for April 12th
I'm not ready to make a reservation, but I would like more information. Please contact me.
VIP Child Name
First Name
Last Name
List names and ages of any siblings of the VIP who would like to attend Buddy Break
If your VIP has attended Buddy Break with us previously, you may scroll to the bottom and submit. If your VIP has never attended Buddy Break at North Highlands, please continue filling out the form.
VIP Birth Date
Please select a month
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Day
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Year
VIP Gender
Male
Female
Parent/Caregiver Name
First Name
Last Name
E-mail
example@example.com
Phone Number
May we text you at this number?
Yes
No
Additional Comments
If this is your VIPs first Buddy Break, a parent or guardian will need to attend a one-time, one-hour orientation that will begin at 6:00 on their first night of Buddy Break. Following this, the VIP and siblings will be able to attend any Buddy Break across the country with appropriate reservations.
Submit
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