Campus Days Registration Form

A registration form must be completed for each individual attending.

Name(Required)

First Last

Biological Sex(Required)

Male

Female

I Am Registering As(Required)

$75 Student

$75 Adult

$0 Youth Leader/Pastor who will attend all weekend activities.

Early bird pricing is available through April 7. After April 7th registration will be $110 for students, adults, and $75 for youth leaders/pastors who will attend weekend activities.

Birth Date(Required)

Grade(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Mobile Phone(Required)

Hidden

Home Phone

Email(Required)

T-Shirt Size(Required)

Those who attend Campus Days will receive a free FLBC T-shirt.

Housing:
Guests are asked to secure their own housing arrangements. Discounted rates are available at a local hotel through March 24 . Reservations can be made using the links on the Campus Days event page. Transportation to and from the hotel is the responsibility of the Campus Days guests.

Church(Required)

Medical Release

- To be filled out by parent if registrant is under 18 years of age, or by registrant if over 18. Any documents with incomplete or incorrect initials, names, or dates will be considered void.

Parent or Legal Guardian Emergency Contact - Name(Required)

Parent or Legal Guardian Emergency Contact - Mobile Phone(Required)

Hidden

Insurance Company/Health-Sharing Ministry

Hidden

Plan/Policy Number

Hidden

Family Physician

Hidden

Physician Phone

Activities:

Riding in a vehicle with staff driver or student driver to and from off-campus activities.
General on-campus recreation
Skate Night at Skateville in Burnsville

I consent to my child participating in the above named activities, minus any exceptions I will list below. In signing this assumption of risk, I certify that my child is able to participate in the activity or activities. If I am 18 or over, I am signing this assumption of risk for myself.

Initials(Required)

I will not/I do not want my child to engage in the following activities:

Initials(Required)

Below are allergies or medical conditions that may be relevant to the FLBC kitchen staff in meal prep or to a physician in the event of an emergency:

Initials(Required)

I authorize FLBC staff who are in charge of any specific activity to make emergency medical decisions for my child in the event I cannot be reached. I will immediately notify the person in charge of any activity of any change in the information presented here. I agree that this Assumption of Risk shall be valid until I revoke it. I have signed this Assumption of Risk both in my own capacity as a parent/guardian of my child and in a representative capacity on behalf of my minor child. I represent and warrant to FLBC that I have completed this Assumption of Risk form for my child to participate in this activity; that it is complete and correct in all its information; that I have inserted my initials beside each completed item; and that I have dated the form and typed my name below to represent to FLBC my intent to be fully bound in accordance with its terms.

Initials(Required)

Media Release

I consent for my child to appear in photos or video footage of this event that may be used in FLBC promotional materials. If I am 18 years of age or older, I give my own consent.

Initials(Required)

Signature

Full Name of Parent/Legal Guardian (or registrant if over 18)(Required)

Date(Required)

Total

Credit Card

Card Details

Cardholder Name

You will receive a confirmation email when your Campus Days registration has been successfully submitted. If you do not receive a confirmation email, please notify admissions@flbc.edu.

Communications

I would like to receive email updates regarding future events at the Free Lutheran Bible College and Seminary.

FLBC maintains a No-Refunds policy for all events.