Rochester Life

Registration for "Nitro 2.0 Kids Conference"

Registration for "Nitro 2.0 Kids Conference"page 1 of 1

Trip Details

DUE DATE: Register and pay by Sunday, March 3rd.


WHEN: Friday, March 15 (Be at Rochester Life parking lot by 3:30pm) THRU Saturday, March 16 (We expect to return at 5:00pm on Saturday)


WHAT TO BRING: sleeping bag, pillow (air mattress if desired), toiletries, clothes and Bible.


The cost of this event is $59 per child. Additionally, you will need to send money with your child for one fast-food meal stop. Note: If you are registering more than one child, you will need to complete a separate registration for each child.
Cost: $59.00 each *
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Nitro 2.0 Kid's Conference T-shirt Available in: Kids S, Kids M, Kids L, Adult S, Adult M, Adult L, Adult XL, Adult XXL.
Cost: $12.00 each
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Child's Information


First Name Last Name

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I AGREE.



Parent/Guardian Information


First Name Last Name
Phone Number
Address
Address Line 2
City State Zip Code
Email Address
As the parent/guardian of the above child, I give my permission for his/her participation in Nitro Kids Conference in Bothell, WA organized by Rochester Life A/G. I recognize that with any trip, there are risks and I release Rochester Life of any liability from any injury or loss resulting from this trip. I also give Pastor Lyndie Burnett or any approved adult leader of the church permission to act on my behalf in the administration of any medical or legal attention necessary in case of an emergency on this trip.
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I AGREE.



Insurance Information


Phone Number


First Name Last Name



Emergency Contact Information


First Name Last Name
Phone Number




* required