UpClose Registration Form Please submit one registration form per person attending. Guests are asked to secure their own housing arrangements. All late registrations require a $40 non-refundable payment. 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 This field is hidden when viewing the form(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*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Grade*Choose Grade1112Already GraduatedChurch*Church Name, City, and StateEmail* Address* Street Address City State / Province / Region ZIP / Postal Code Mobile Phone*Text Message Opt-InYou must opt-in in order to receive SMS messages. Messaging frequency varies. You may opt-out at any time. Standard messaging rates may apply. This number can receive SMS/Text messages and I opt-in to receive SMS messages. Media Release - Filled out by parent if under 18 I give consent for my image/my child's image to appear in photos or video footage of this event that may be used in FLBC promotional materials. Medical Information- To be filled out by parent if under 18 years of age.Parent/Guardian Emergency Contact - Name*Parent/Guardian Emergency Contact - Mobile Phone*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:Liability Waiver & Medical Release*Free Lutheran Theological Seminary Corporation d/b/a Free Lutheran Bible College & Seminary (FLBCS) Facilities Use Liability Waiver and Medical Release 1. Free Lutheran Bible College & Seminary assumes no liability for any damages or losses to persons or property arising out of the use of the FLBCS facilities. User agrees that neither FLBCS, nor its trustees, agents, employees, representatives, successors or assigns, may be held liable in any way for any claims, damages or losses arising in any way out of the use of the facilities of FLBCS, including, but not limited to any claims by User. User agrees to indemnify and hold harmless FLBCS, its trustees, agents, employees, representatives, successors and assigns against any and all claims, losses, injury or damage arising in any way out of the event or use of the facilities, including but not limited to, all court costs and attorney’s fees incurred by any indemnified party. 2. User agrees to honor all rules and regulations imposed by FLBCS for the facilities. 3. I authorize FLBCS 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 event coordinator of any change in the information presented here. I agree that this Assumption of Risk shall be valid until I revoke it. I sign 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 agree to the terms and conditions of the Liability Waiver and Medical ReleaseSignaturesFull Name of Parent/Guardian (or registrant if over 18)*Date* This field is hidden when viewing the formLate Registration $40 Credit CardFeed Required: To use the Stripe field, please create a Stripe feed for this form. Δ
