Winter 24 Registration From

Please fill out this form and click submit.
Sunday Feb.16th at 12:00pm
JR. High & High School

Student Contact Info:

Current Grade In School

*

Name

*

Address

*

Phone #1

*

Phone #2

*

Date of Birth

*

Gender

*

Parent or Guardian's Name

*

Parent or Guardian's Work #

*

Church Student Attends

*

Emergency Contact Name

*

Emergency Contact #

*

Email

*

This address will receive a confirmation email

T-shirt Size (Late registrations are not guaranteed a t -shirt.)

*

Please select one option.

YS YM YL S M L XL XXL XXXL XXXXL

List any Special Medical Problems or Allergies

*

Special Dietary Needs

*

Medical Info (Required)

Ins. Company

*

Policy Holder

*

Group Number

*

Ins. Phone #

*

By finishing this form, you give permission for your child to attend Winter 24. You understand that every precaution will be taken for the safety and well-being of your child, but in the event of an accident, Orchardville Church along with its staff and volunteers, are hereby released from any and all liability.

Payment $35

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

Please fill out this form and click submit.
Sunday Feb.16th at 12:00pm
JR. High & High School

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