Centershot & Kicking Bear Adventure Day

Centershot & Kicking Bear Adventure Day at FIRST FREE CHURCH

Event Registration Form - Sunday, January 24th, 2021
This form must be signed by a PARENT or LEGAL GUARDIAN; one form can be submitted for each family. The Attendee does not have to be a legal guardian.
Choose one option; If you are bringing your own children as well as others, each parent/guardian needs to complete this form separately. *

Parents or legal guardians will be responsible for the registered youth. A friend, adult family member, or mentor of the youth will be responsible.
How many youth from your family will be attending? *
Youth Name *

First Name Last Name
Age of Youth *
Age
Youth Name (Only fill in for additional children with same legal guardian)

First Name Last Name
Age of Youth
Age
Youth Name (Only fill in for additional children with same legal guardian)

First Name Last Name
Age of Youth
Youth Name (Only fill in for additional children with same legal guardian)

First Name Last Name
Age of Youth
Age
Youth Name (Only fill in for additional children with same legal guardian)

First Name Last Name
Age of Youth
Age

Address of Youth and Legal Guardian *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email (Used to send reminders or updates on weather, etc.) *
example@example.com
*

As the parent or legal guardian, I acknowledge that the above information is to be used in lieu of an Emergency Medical Release Form(see below), and that the Attending Adult named is responsible for my child/children while at camp if different from parent.
Emergency Medical Release Form
*

As the parent or legal guardian, I have read the Release of Liability and Assumption of Risk Agreement (see below), and I fully understand its terms, and understand that I have given up legal rights by clicking and signing this form, and I do so freely and voluntarily without any inducement.
Release of Liability and Assumption of Risk Agreement
*

As parent or legal guardian, I have read the Photo/Video Release Form (see below) and understand that if I DO NOT wish to have my child's image used by Kicking Bear, it is my responsibility to notify the host Kicking Bear team at check-in/registration.
Photo/Video Release Form
Additional Comments or Questions.
Email info@kickingbear.org with any immediate questions or concerns.
Please follow our event on facebook at www.facebook.com/kickingbear1on1 to stay updated. See you there!!
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Centershot & Kicking Bear Adventure Day at FIRST FREE CHURCH