Upclose Registration

There is no registration fee for this campus visit event.
Guests are asked to secure their own housing arrangements. Marriott reservations must be made by October 6th to receive the group rate. For more information visit the UpClose event page.
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

I Am Registering As*

Student
Chaperone
Parent

Gender*

Male
Female

Birth date*

Grade*

Address*

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

Phone*

Home Phone

Email*

Church*

Church Name, City, and State

Emergency Contact Name*

Emergency Contact Mobile Phone*

Insurance Company/Health-Sharing Ministry*

Plan/Policy Number*

Family Physician

First Last

Physician Phone

Image Release - Filled out by parent if under 18

I give consent for my own/my child's image in a photograph and/or video to be used for promotional purposes. I understand I will not be compensated for the use of these images.

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:

General on campus recreation

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*

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

Initials*

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.