Kids Days at LBBC Registration Form

Child's Name (please complete one form for each child from your household that you are registering; Age requirement: Finished 1st grade through high school)

Gender

Male Female

Birthdate (MM/DD/YYYY)

Please check the age group that applies to your child:

Frontier Kids (finished 1st-3rd grade) Trailblazers (finished 4th-6th grade) Junior High (those that have completed 6th grade are welcome here also) Senior High

Address

Parents/Guardian

Home Phone

Work Phone

Cell Phone

This address will receive a confirmation email

List names and phone numbers of other adults authorized to drop off/pick-up your child

Emergency Contact & Relationship to Child

Emergency Contact Phone

Special Needs: (learning, behavior, diet, medical, allergies) What can we do to help with these needs?

Yes No

If yes, please share about these special needs:

I would like to register my child for the following Kids Days at LBBC dates (check all that apply, $15/child per event date except for August 4th which is $25 because it is an overnight so an extra $10):

Tuesday, June 30, 2020 Tuesday, July 21, 2020 Tuesday, August 4, 2020

I agree that I will complete the required liability waiver form prior to my child's participation (updated in June 2020 so all must sign a new one).

Yes No

I agree to pay $15 for this child to participate in each Kids Day at LBBC date chosen above ($15/child per event date of June & July, $25 for August as it is an overnight event). I will mail or drop off my payment to the church office and understand that my registration payment must be made in a timely manner in order to fully confirm/reserve my child's registration.

Yes No

Kids Days at LBBC Registration Form

Description

Please Fix the Following