Parent/Guardian Name *

First Name

Last Name

Parents/Guardians Phone *

(###)

###

####

Sponsor Name

(If information is the same as above, please ignore)

First Name

Last Name

Sponsor Phone

(If information is the same as above, please ignore)

(###)

###

####

Childs Name *

First Name

Last Name

Food Allergy? *

We will be providing lunch and light snacks at this event. For the safety of all attendees, please let us know if your child has a food allergy.

Yes

No

Childs Name

First Name

Last Name

Food Allergy

Yes

No

Childs Name

First Name

Last Name

Food Allergy?

Yes

No

Childs Name

First Name

Last Name

Food Allergy?

Yes

No

Childs Name

First Name

Last Name

Food Allergy?

Yes

No

*

I acknowledge that this event is for teenagers 13-17 years old.

I acknowledge that each teenager MUST be sponsored by an adult. That adult MUST sign in/out all sponsored attendees on both days of the event.