THE EVENT: OPEN YOUR EYES

J U N E 2 3 - 2 7 , 2 0 2 5

GENERAL INFORMATION

Name

Grade (Fall of '25)

Home Church

Parent Email

This address will receive a confirmation email

SAFETY FORM

Every registered student must have a completed safety for to attend THE EVENT

Date of Birth

Address

Mother's Name / Phone Number

Father's Name / Phone Number

In Case of Emergency, call:

Emergency Contact #2 (Name and Phone Number)

Any Known Allergies:

Any Known Medical Conditions:

Medications / EpiPens:

THE EVENT Shirts $10.00

Select Size Small Medium Large X-Large 2X-Large

PAYMENT

Cost: $40.00 Per Person

**Add $10 to your total cost if you would like to pre-order a t-shirt**

PAYMENTS CAN BE MADE ONLINE -OR- IN PERSON

Payment

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

Please fill out this form and click submit.