East Immanuel Refuge 2026/2027
Child’s Name
*
First Name
Last Name
Guardian’s Name
First Name
Last Name
Child’s Grade
Guardian’s Phone Number
*
Format: (000) 000-0000.
Guardian’s Email
example@example.com
Wednesdays
6:30-8:00 pm. Doors open at 6:15.
K-8th grade
Submit
Should be Empty: