REconnect Sign-up
Third Friday of the Month
$10 per family from 6-9pm
$15 per family from 6-11pm
sign up
 
Parent/Guardian's name *

 
What's a phone number we can reach you at? *

 
How many children will be attending REconnect? *


 
Please list all the names and ages of your children *

 
Which Childcare Package would you like?


 
Would you like us to provide meals? *

Meals are available for $2 per child
     
 
Please feel free to take this brief survey on REconnect and our services.

 
Please take a moment to rate REconnect

What would you rate REconnect from 1 being the Lowest to 5 Being the the Best.





 
How likely would you be to recommend REconnect to a friend?

1 being not likely to 5 being highly likely





 
Do you have any suggestions?

Please feel free to write down any comments, concerns or suggestions
 
I understand that accidents happen and that injuries may occur at times. I agree not to hold "REconnect" or any other "Road to Life Church" affiliate responsible for injuries or accidents that may take place during REconnect. *

If you do not accept please understand that you may be refused service at REconnect.
     
Thanks so much for your RSVP
We can't wait to see you there!

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