Lab Registration – Bridge Street Ministries

Email*

Student Name*

First Last

Student Grade*

Choose

Lab Offerings*

Select the lab(s) you would like to register for:

ROBOTICS LAB - Mondays, 2:30-4:30 pm
BIBLE LAB - Tuesdays, 2:30-4:30 pm
ART LAB - Wednesdays, 2:30-4:30 pm
BLANDFORD NATURE CENTER - Thursdays, 2:30-4:30 pm

What school do you attend?*

Your answer

What's the name of the Resurgence student who recommended you?

Your answer

Address*

Street Address Address Line 2 City State ZIP Code

Parent/Guardian Name*

First Last

Phone*

Emergency Contact Name*

First Last

Emergency Contact Phone*

Consent*

Transportation from school, to labs, and drop-off at home is provided by Bridge Street Ministries and available for all registered Resurgence students. Students will be dropped off at the address listed above unless otherwise instructed by a parent or legal guardian. By checking this box, you are authorizing Bridge Street Ministries (BSM) to provide transportation for the student listed above during the duration of this lab. This form grants Bridge Street Ministries permission to use my/our child's photos in any of their promotional advertisements.

I am a parent or legal guardian of the student listed above, and hereby consent to the terms listed on this form.

Resurgence Lab Registration

Bridge Street Ministries