Breeze Kids - Pre-Registration Form

We're so glad you're going to join at for Breeze Kids!
Service times are 9am and 11am Sundays at both locations!
Wednesdays at 7pm at the North Fort Myers Location.

Please fill out all information so we can best prepare for you and your family when you decide to join us!

Under HOUSEHOLD MEMBERS you will add your children and spouse (if applicable)

Your name *

Email address *

Phone number *

Address

Marital status *

Which location will you be attending? *

Cape Coral Location launches Sunday, October 5th!

Which service are you planning to attend? *

9:00 am - Sunday

11:00 am - Sunday

7:00 pm - Wednesday (North Fort Myers Location Only)

Depends on how the day goes!

Household members

Please add your spouse (if applicable) and children in household. Birthdate for all children is required and Grade is also required if applicable. Medical notes: Please let us know of any allergies / medical needs.

Do you have any questions or comments we may need to know about you or your family?

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