Kings Island 2024

PARTICIPANT or YOUTH COACH INFORMATION

Name

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Phone

PARENT or EMERGENCY CONTACT INFORMATION

Parent Name or Emergency Contact

Parent or Youth Coach Email

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Parent or Youth Coach Phone

PHOTO/VIDEO RELEASE:

Please be aware that this event may be photographed. Your submission of this form and participation in the event grants Park Chapel permission to use your picture, silhouette or reproductions of your physical likeness and voice in any manner associated with promotion and/or celebration of church events.

Payment

Credit/Debit Card Number

Expiration Date/CVC

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Description

Wednesday June 12th 2024

Please fill out this form and click submit.

Where: Kings Island
When: Wednesday, June 12th 2024
Time: 8 am - 8pm
Who: High School Students (incoming 9th - graduated 12th)

If you have any questions please email Katryna at kcoonce@parkchapel.org

Kings Island 2024

Description

Please Fix the Following