Campus Days Registration Form

Registration form must be completed separately for each individual attending.
Name*
First Last
I Am Registering As:*
- $75 | Student
- $75 | Adult
- $0 | Youth Leader who will attend all weekend activities
Gender*
- Male
- Female
Birth date*
Date Format: MM slash DD slash YYYY
Grade*
Address*
Street Address City State / Province / Region ZIP / Postal Code
Mobile Phone*
Home Phone
Email*
T-shirt Size*
Those who attend Campus Days will receive a free FLBC T-shirt.
Housing
- Guests are asked to secure their own housing arrangements.
- Mayny guests have booked rooms at the Hilton Garden Inn in Maple Grove, MN.
- Reservations can be made via phone (763-509-9500 and mention "Free Lutheran Bible College").
- One adult chaperone is required for every ten minors at the motel.
- The rooms have two queen beds and can accommodate four people.
- Transportation to and from the motel is the responsibility of the Campus Days guests.
Church*
Church Name, City, and State
Parent or Legal Guardian Emergency Contact Name*
Parent or Legal Guardian Emergency Contact Mobile Phone*
Insurance Company/Health-Sharing Ministry*
Plan/Policy Number*
Family Physician
First Last
Physician Phone
Medical Release Form
- To be filled out by parent if attendee is under 18 years of age, or by attendee if over 18.
Instructions: Read while filling in all required information and give full initials for each entry. Each field requires a response. Any documents with incomplete or incorrect initials, parent/guardian name or dates will be considered void.

Activities:
- Riding in a vehicle with staff driver or student driver to and from off campus activities.
- General on campus recreation
- Skate Night at Roller Garden
I consent to my child participating in the above named activities. 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.
Initials*
I do not want my child to engage in the following activities:
Initials*
Below are allergies or medical conditions that may be relevant to a physician in the event of an emergency:
Initials*
I authorize FLBC staff or students 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.
Signatures
Full Name of Parent/Legal Guardian (or student if over 18)*
Date*
Date Format: MM slash DD slash YYYY
Payment Method*
- Pay online
Online payment is required at the time of registration. Students and adults will be redirected to a secure online payment portal after submitting their registration.
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.
Email
This field is for validation purposes and should be left unchanged.

Campus Days Registration Form

Medical Release Form

Signatures