Lab Registration – Bridge Street Ministries

Marking Period 1

Email*
Student Name*
First Last
Student Grade*
Choose
Lab Offerings*
Select the lab(s) you would like to register for:
- S.T.E.M. LAB - Mondays, 2:30-4:30 pm
- BIBLE LAB - Tuesdays, 2:30-4:30 pm
- ART LAB - Wednesdays, 2:30-4:30 pm
- PHYSICAL ACTIVITY LAB - Thursdays, 2:30-4:30 pm
- MENTORING - Fridays, 2:30-4:30 pm
What school do you attend?*
Your answer
How did you hear abou Resurgence?
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.