Drop & Shop Registration

All fields must be complete for each child registering for an NBGC sponsored activity.

Requests will be considered but they cannot be guaranteed. All requests must be made in writing on this form at the time of registration.

CheeseSausagePepperoniThey will bring their own lunch

Requests will be considered but they cannot be guaranteed. All requests must be made in writing on this form at the time of registration.

CheeseSausagePepperoniThey will bring their own lunch

Requests will be considered but they cannot be guaranteed. All requests must be made in writing on this form at the time of registration.

CheeseSausagePepperoniThey will bring their own lunch

Requests will be considered but they cannot be guaranteed. All requests must be made in writing on this form at the time of registration.

CheeseSausagePepperoniThey will bring their own lunch

Address

Street Address Line 2

City, State, Zip

Address

Street Address Line 2

City, State, Zip

I hereby give permission for me/my child to participate in the Neighborhood Boys & Girls Club. I fully assume all responsibility for injuries she/he/they or I may receive or articles lost while participating in these activities or while in travel to or from said activities, and hereby release the Neighborhood Boys & Girls Club and its employees from liability for any injury my child(ren) or I may sustain. I hereby grant permission to the Neighborhood Boys & Girls Club for the use of any and all photos/videos in which my child(ren) or I may appear. The usage is inclusive of, but not limited to, the publication or inclusion in brochures, posters, catalogs, websites, handbooks, banners, and broadcast or print advertisements. I agree to walve any claim to compensation for use of said photos/videos.

In the event of a medical emergency, I hereby authorize and give my consent to the Neighborhood Boys & Girls Club and its employees, coaches and/or volunteers to secure from any accredited hospital, clinic, and/or physician any treatment deemed necessary for my child(ren)'s or my immediate care. I agree that I shall remain responsible for any and all expenses incurred for such emergency medical care and treatment.

Yes, my child(ren) can participateNo, my child(ren) cannot participate

Form must be completed in its entirety.

Drop & Shop Child 1

$30.00 Quantity

Drop & Shop Child 2

$15.00

Drop & Shop Child 3

$15.00

Drop & Shop Child 4

$15.00

Total

$0.00

Credit Card

Drop & Shop Registration

All fields must be complete for each child registering for an NBGC sponsored activity.

Child 1 Information

Child 2 Information

Child 3 Information

Child 4 Information

Parent & Family Information

Parent 1 Information

Parent 2 Information

Emergency Contacts Information

Participation Agreement

Form must be completed in its entirety.

Credit Card