Upclose Registration

Late Registration Fee - $40
Guests are asked to secure their own housing arrangements.
You will receive a confirmation email when you successfully submit your registration. If you do not receive this email please contact admissions@flbc.edu.

Name*

First Last

Biological Sex*

Male
Female

I Am Registering As*

Student
Chaperone
Parent

(Optional) I will be staying for the UpClose Add-on, Friday afternoon/evening

Regular UpClose activities conclude at 2pm on Friday. Check this box if you plan to stay for the add-on afternoon activities, a free dinner, and the alumni basketball and volleyball tournament that evening.

Birth date*

Grade*

Address*

Street Address City State / Province / Region ZIP / Postal Code

Email*

Mobile Phone*

Text Message Opt-In

This number can receive SMS/Text messages and I opt-in to receive SMS messages.

You must opt-in in order to receive SMS messages. Messaging frequency varies. You may opt-out at any time. Standard messaging rates may apply.

Hidden

Home Phone

Church*

Church Name, City, and State

Hidden

Insurance Company/Health-Sharing Ministry

Hidden

Plan/Policy Number

Hidden

Family Physician

First Last

Hidden

Physician Phone

Media Release - Filled out by parent if under 18*

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.

Medical Release Form

- To be filled out by parent if attendee is under 18 years of age, or by attendee if over 18.

Parent or Legal Guardian Emergency Contact - Name*

Parent or Legal Guardian Emergency Contact - Mobile Phone*

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:

General on campus recreation

I consent to my child participating in the above named activities. If I am 18 or over, I am signing this assumption of risk.

Initials*

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

Initials*

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

Initials*

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/each of us have/has 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 / each of us have/has inserted my/our initials beside each completed item; and that I/we have dated the form and typed my/our name(s) below to represent to FLBC my /our intent to be fully bound in accordance with its terms.