Districts Sign-Up Form

Student Name

Parent's Name

Parent Email

This address will receive a confirmation email

Parent Phone

Student Phone

Grade

Emergency Contact Name and Phone #

Allergies/Medications

Other - Please list any other information we need to know.

Waiver & Insurance

My Student has Medical Insurance

Yes No

If Yes, Please list insurance company and plan #.

I hereby give my child permission to participate in the Range Community Bible Church trip to Green Bay Wisconsin on January 15th-17th 2027 Including riding in the church van or another vehicle, and staying overnight in a hotel.

Yes No

Description

Please fill out this form and click submit.
Please either make a check payable to RCBC for full amount or go to
https://give.tithe.ly/?locationId=b31832de-7ac1-4c6b-bcb9-53f0632be954
Click "funds" and click Districts Youth Conference - Be sure to cover the fees if possible :)

Districts Sign-Up Form

Description

Please Fix the Following