SOS: Students of Success

---

Springfield Baptist Church Dr. Kevin D. Sturdivant, Pastor

Back to School Event Registration Form (Registration Deadline: August 16th)

SOS: Students of Success Event Date: August 24, 2019 Time: 11:00-4:00 General Information: • • • • •

Information/Resources provided to help your child(ren) be more successful in school. Event includes Interactive Sessions, Inspirational Speaker, Concert, School Supplies, Prizes! Parents are encouraged to attend with your child (ren). Parent Sessions Parents, please provide complete contact information Lunch and Snacks will be provided.

Essay Contest! and/or

Reading Contest!

Registration: Name of Student

Name of Parent/Guardian

Phone Number

Full Address

Email Address

Grade Level (2019-2020)

Allergies: Name of Student

Allergy

Immediate Treatment

Emergency Contact Name & Number

Member of Springfield Baptist Church: ____Yes ____No School Attending in the Fall: _______________________________________________ Educational/Learning Concerns: ______________________________________________________________________________________ ________________________________________________________________________________________________________________