REGISTRATION FORM
(SELECT UP TO 4 DAYS)
SELECT DATE(S) OF CAMPUS VISIT
(SELECT UP TO 4 DAYS)
*
Friday June 2, 2023 - Emory University and Gwinnett Technical College
Monday June 5, 2023 - Georgia State University and Georgia Tech
Tuesday June 6, 2023 - University of North Georgia and Georgia Gwinnett College
Wednesday June 7, 2023 - University of Georgia and Kennesaw State University
SELECT PICK-UP & DROP-OFF LOCATION FOR FREE TRANSPORTATION
(SELECT 1 SITE CLOSING TO STUDENT'S HOME)
*
Site #1 8:00 AM / Gainesville at Walgreens (3414 Mundy Mill Rd, Gainesville, GA 30507)
Site #2 8:45 AM / Gwinnett at Huy Sandwich (6100 Live Oak Pkwy, Norcross, GA 30093)
Site #3 9:00 AM / Morrow at VN Pho (6363 Jonesboro Rd, Morrow, GA 30260)
STUDENT INFORMATION
Student Full Name (tên và họ)
*
First Name
Last Name
Grade Level 2022 - 2023 (lớp học)
Enter grade of student
Address (Địa chỉ nhà)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Student E-mail
example@example.com
Careers and/or Areas of Interest
PARENT INFORMATION
Parent Full Name (tên và họ)
*
Prefix
First Name
Last Name
Phone Number (Số điện thoại)
*
-
Area Code
Phone Number
Parent E-mail
example@example.com
EMERGENCY CONTACT INFORMATION
Complete if parent or guardian don't attend the tour with student
Full Name (tên và họ)
Prefix
First Name
Last Name
Relationship
Phone Number (Số điện thoại)
-
Area Code
Phone Number
RELEASE OF LIABILITY
Agree to release The Vietnamese Baptist Ministry of Gainesville, Georgia, from all liabilities associated with any of ours or our participants accidents or mishaps that may occur at the during the Georgia College Tour.
PARTICIPATION CONSENT
The undersigned consents to participate in any and all activities, including he undersigned gives permission for the Participant(s) to participate in any and all activities, including transportation during Georgia College Tour activities, except those specifically prohibited by the participant’s physician or parent/legal guardian). In the event of emergency and parent and guardian are not reachable, we grant consent for securing health care for our underage children.
Signature
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