2025 Girls Day Out Registration Form

Heartland Region Girls Day Out Registration Form
Sept 20th, 2025 | 9am - 4pm

* Please complete one registration form per person (All Students & Leaders, Chaperones, Parents attending must register).

* If you wish to help work this event (set up, tear down, assist in activities, serve food, etc.), please contact Mycah Baker @ 423-912-0946. - workers do not need to complete registration.

* The cost for the event is $25 per Student and $20 per Leader, Chaperone, or Parent. This fee covers event admission, lunch, and a complimentary 2025 Girls’ Day Out T-shirt.

* Please note that registrations after August 1, 2025, or walk-on participants will not receive a T-shirt as they are ordered prior to event. Additional T-shirts can be ordered at the end of this form or by contacting Mycah Baker before August 1, 2025.

For any questions, feel free to text 423-912-0946.
I am registering a*

StudentLeader/Chaperone/Parent
Will you be attending with a church group?*

Yes, I am coming with my churchNo, I am attending individually
Your Local Church Name*
City & State of Local Church*

Leader/Chaperone/Parent

Personal Information
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Phone Number*

Area CodePhone Number
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
T-shirt Size:*

Adult SmallAdult MediumAdult LargeAdult X-LargeAdult 2XLAdult 3XL
List Any Allergies and/or Dietary Restrictions [Please state "none" if this does not apply]*

Heartland Region Girls Day Out Registration Form