Upclose Registration

There is no registration fee for this campus visit event.
Guests are asked to secure their own housing arrangements. 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

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

Mobile Phone*

Hidden

Home Phone

Email*

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.