Buddy Break
Kids K - 5th Grade • December 14 11AM-3PM • Harvest Time Bible Church • 1802 Dixon Rd, Rock Falls, IL 61071
Student Name
*
First Name
Last Name
Grade
*
Please Select
K
1st
2nd
3rd
4th
5th
Currently Buddy Break is only for K-5th grade.
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Email
*
example@example.com
Parent/Guardian Phone Number
*
Please enter a valid phone number.
How many VIPs (Very Important People) will be coming?
*
How, if any, many VIP siblings will be coming?
Submit
Should be Empty: