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BigStuf Registration

Student's First and Last Name (required)

Grade Completed as of June 2012 (choose from drop-down list)

School's Name

Gender
 Female Male

Student Cell Phone Number

Student Facebook Name

Parent Name (required)

Parent Phone (required)

Parent Cell

Parent Email (required)

Street Address (required)

City (required) State (required) Zip (required)

Medical Release Form On File?
 Yes No

BigStuf Consent Form turned in?
 yes no

These forms are available on the PDFs page - located at
fumcclinton.org/youth/pdfs

Total cost is $295, deposit is $100
Have you paid your deposit yet?
 Yes No
If not, your spot is not guaranteed until it has been paid.

Rooming requests:
(requests can not be guaranteed)

Special Requests, Needs or Comments