Movie Night Registration Form

CAMPUS LIFE MOVIE NIGHT

Fill for out completely!
Participant Name

First NameLast Name
Participant Phone Number
Participant Email
example@example.com
Birth Date

MonthDayYear
Date
Age
Gender
Club/School
Grade
Consent and Release of Liability
I represent that I am the participant named below (if 18 or over) or the legal parent/guardian of the child named below, who is under 18 years of age. In consideration for allowing my child to participate in this activity and ongoing YFC activities, I hereby consent to the foregoing on behalf of my child and agree that this release shall be binding upon me, my child, our heirs, legal representatives and assigns.
Participant Signature
Date

MonthDayYear
Date
Parent/Legal Guardian Signature (if participant is under 18)
Parent/Guardian Name

First NameLast Name
Parent/Guardian Phone Number

Area CodePhone Number
Date

MonthDayYear
Date
Please verify that you are human
Should be Empty:

CAMPUS LIFE MOVIE NIGHT