6856 Bellaire Blvd.
Houston, TX 77074
713-271-6001


Schedule of Events

 Friends of HARC

Register On-Line

In order to assist parents,we have made our registration forms availible on-line. Simply fill out the form below, so that we will know that your child will be attending the program. We will contact you about HARC's program(s).

All information given on the form below is simply meant to assist the HARC staff in better serving you and your child. All information is considered strictly confidential.

Please note that written copies of this form, as well as information about HARC and its programs, can be received by clicking the "printable brochures" link above, or through the HARC office (e-mail harc@harc-hou.org for more information).

 

Child's Name:  

Address:  

City:       State:    Zip:

Phone:( )  -

Email Address:

Date of Birth: / /
Note: For children younger than 4 or older than 20, please contact the HARC offices at (713)271-6001 for more information.

School Attending:

List all Special Needs a your child may have
(including ALL allergies, medications, phyical needs):

Parents / Guardians Names:

Mother's Home Number ( ) -
Cell: ( ) -     Work: ( ) -

Father's Home Number ( ) -
Cell: ( ) -     Work: ( ) -

1st Emergency Contact Name:
Relationship: Phone:( ) -

2nd Emergency Contact Name:
Relationship: Phone:( ) -

HARC has my permission to use photographs and video of my child or me for publicity purposes such as brochures, websites, and video broadcasts:
Yes:       No:

We are hoping to attend:
HARC's Friday Parents Night Out
Gethsemane United Methodist Church's Sunday School Program
Gethsemane United Methodist Church's "SMILE" Worship Program

Please note that submitting of this form in no way obligates you or your child to HARC programs.

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by the Houston Area Respite Center.
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