Breaking Bread Sign-up

Friday, March 28 @ 5:30pm to 8pm | Please fill out this form and click submit.

Person #1 Name

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Person #2 Name (if applicable)

Email

*

This address will receive a confirmation email

Phone

*

Host Sign Up

If you would like to be a host, please provide us with the information below.

Sign me up as a host

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Please select all that apply.

Yes, please. Not at this time.

How many people are you able to host?(type N/A if not applicable)

*

Childcare | Drop off at 5:15pm, Pick up at 8:15pm

If you need childcare, childcare will be provided at the church. You can drop off your child(ren) as early as 5:15 pm. Dinner will be provided. We ask that those who are able, give $5 per child, to cover the cost of dinner for your child(ren).

You can pay ahead at the bottom of this form or with cash or check when you drop off. If you intend to pay with cash or check, select "N/A".

I need childcare.

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Please select one option.

Yes, please. No, thank you.

# of Children and ages (type N/A if not applicable)

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Please select one option

N/A ($0) 1 Child (5) 2 Children ($10) 3 Children ($15) 4 Children ($20) Custom Amount

Amount

Comments/Questions:

*

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

Friday, March 28 @ 5:30pm to 8pm

Please fill out this form and click submit.

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