First Name
Last Name
Phone Number*
Address Line 1
Address Line 2
Postal Code
Are you male or female *
What Grade are you in? *
School *
Parent has given verbal permission for student to attend the overnight event at FBC Liberal on the night of MArch 9th, 2018. Parent acknowledges that the student is to be picked up at 7:00 a.m. on Saturday, March 10th.*
Parents Name*
Parent Phone Number*
Please list any food allergies or any other allergies you may have
I have attended CRASH Youth ministry services before the lock-in:*
I acknowledge that the indoor pool and Sauna are open and will bring appropriate swimming attire to swim
I would like to play in the following tournaments

Any further questions or information please call either Adam (918)519-2795 or the church office (620)624-1641. 

*Please note the church needs to VERBALLY hear from the listed parent/guardian in order for registration to be complete*