Boys and Girls Leadership Development
Parent/Guardian Information
I am the child's....
*
Parent
Guardian
Family Member
Sponsor
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Church Name or NLC Campus
*
I Will Attend With The Child
*
Yes
No
Boy's / Girl's Information
Name
*
First Name
Last Name
Gender
*
Male
Female
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
School Grade
*
Allergies
*
Enter N/A if not applicable.
Medications
*
Enter N/A if not applicable.
Has this boy/girl attended any previous Boys & Girls Leadership Development events?
*
Yes
No
Payment
*
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next
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Child Registration
$
35.00
Parent/Guardian
$
10.00
Credit Card
Submit
Should be Empty: