Amazing Race 2017 Student Registration
Amazing Race runs from June 27-30, 2017. It is available to students age 14-19.
Registration ENDS April 30th.

The cost is $355 per person.

ONLY 180 SPOTS!!! Register early!!!
Student's Last Name
Your answer
Student's First Name
Your answer
Student's Gender
Student's Age
Grade Next Fall
Street Address
Your answer
City
Your answer
State
Your answer
Zip Code
Your answer
Parent's Email Address
Your answer
Parent's Primary Phone
Your answer
Parent's Secondary Phone
Your answer
Associated Congregation
Pastor
Your answer
Student's Shirt Size
Shirts come in adult sizes.
Roommate Request (List up to 3 people.)
Your answer
Health Insurance Company
Your answer
Name on Policy
Your answer
Policy Number
Your answer
Does your child have any special health considerations?
Please mail any necessary papers or attachments to Amazing Race, c/o Hope Lutheran Church, 7430 Belvedere Road, West Palm Beach, FL 33411
Please list any special health considerations.
Your answer
Does your child have any allergies?
Please mail any necessary papers or attachments to Amazing Race, c/o Hope Lutheran Church, 7430 Belvedere Road, West Palm Beach, FL 33411
If YES, please list all allergies here.
Your answer
In the event of an emergency, I understand that every effort will be made to contact me. I give permission for my child to be treated by the camp counselors or at the nearest hospital or medical facility at the discretion of the camp staff. I agree to pay any costs that are incurred and will not hold the camp sponsor or camp staff liable for the cost of any health care provided to my child.
By entering your initials below, you are effectively providing your signature, agreeing with the above text.
Your answer
Date Signed
MM
/
DD
/
YYYY
Trampoline Park Waiver
Click this link to create, print, and sign the waiver which must be brought to the Amazing Race.
https://orlandostore.skyzone.com/waiver/

Please send only one check per congregation, and make the check out to "South Atlantic District Youth Fund."

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