Registration | BISKIDS

Bis Kids Enrollment and Registration

Student Information

Date of Birth

First Name

Last Name

Male

Female

Age

School Attending

Grade

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

Country

Parent/Guardian Information

Name

Phone Number

Additional Information

Any special concerns or problems (medical, behavioral, etc.)?

I give permission to my child to participate in the BIS Kids program. I agree to indemnify and hold harmless The Believe in Sobriety Foundation and all it's subsidiaries and officers from any and all liability incurred as a result of participation by my child. I also agree that the term hereof shall serve as a release and assumption of risk for my heirs, executors and administrators, and for all members of my family.

Signature

I agree to the above terms and conditions

Bis Kids Enrollment and Registration

Student Information

Parent/Guardian Information

Additional Information

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