SMBC Member Release Form

Participant’s Name(Required)

First Last

Home Address(Required)

Street Address Address Line 2 City State ZIP Code

Birthdate(Required)

Age(Required)

Please enter a number less than or equal to 18.

Home Phone

Cell Phone

School(Required)

Grade(Required)

Additional Children

If you are registering additional children, please enter them below. Click "+" to add more than one child.

First Name

Last Name

Birthday

Age

School

Age

Parent/Guardian Name #1(Required)

First Last

Parent/Guardian Name #2(Required)

First Last

Home Address(Required)

Street Address Address Line 2 City State ZIP Code

Cell Phone(Required)

Best Contact Email(Required)

PARENTAL CONSENT AND LIABILITY RELEASE FORM (Member)