Amazing Race 2017 Chaperone 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.

Chaperone's Last Name
Your answer
Chaperone's First Name
Your answer
Gender
Age
Street Address
Your answer
City
Your answer
State
Your answer
Zip Code
Your answer
Email Address
Your answer
Primary Phone
Your answer
Secondary Phone
Your answer
Associated Congregation
If you answered OTHER, please list the congregation with whom you are associated here.
Your answer
Describe your group's travel plans.
Pastor
Your answer
Chaperone's Shirt Size
Shirts come in adult sizes.
Roommate Request
Your answer
Health Insurance Company
Your answer
Name on Policy
Your answer
Policy Number
Your answer
Do you 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
If YES, please list any special health considerations.
Your answer
Do you 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 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 me.
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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