Teen Social Registration « Birmingham Homeschool Fair & Convention

Parent/Guardian Information

This information will be used for security procedures, and we will not use it for any other purpose.

Name*

First Last

Email*

Please indicate the same email address you used for convention registration

Enter Email Confirm Email

Gender*

Female
Male

Date of Birth*

MM

DD

YYYY

Relationship to child(ren):*

Address*

Street Address Address Line 2 City State ZIP Code

Cell Phone*

Additional Information

Please let us know if anyone other than yourself has permission to pick up or take your teen away from our group event.

Make sure your teen is aware that we simply cannot allow them to walk out or leave the group without an approved guardian or arrangement. This is for their safety.

Approved Individuals for Pick Up

Click the plus sign to add more names. Don't forget your spouse!

Name	Date of Birth	Cell Phone

Special Arrangements or Comments:

Please share any special arrangements you have approved for your teen's departure from our event.

Registration

How many teens are you registering?*

1
2
3
4

Teen 1

Teen 1*

First Last

Age*

Please enter a number from 13 to 18.

Date of Birth*

MM

DD

YYYY

Allergies or Special Conditions:

Teen 2

Teen 2*

First Last

Age*

Please enter a number from 13 to 18.

Date of Birth*

MM

DD

YYYY

Allergies or Special Conditions:

Teen 3

Teen 3*

First Last

Age*

Please enter a number from 13 to 18.

Date of Birth*

MM

DD

YYYY

Allergies or Special Conditions:

Teen 4

Teen 4*

First Last

Age*

Please enter a number from 13 to 18.

Date of Birth*

MM

DD

YYYY

Allergies or Special Conditions:

Adult Options

If you will attend with your teen, please register.

Adult - Lunch Buffet Only

No arcade card

Price: $15.00 Quantity:

Adult - Lunch Buffet & Arcade Card

Price: $27.00 Quantity:

Confirmation & Payment

Total

$0.00

Coupon Code

Payment Option*

Credit Card

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

You will be redirected to PayPal to complete payment after submitting this form. If payment is not completed via PayPal, your form will process.

Please insure that your payment is received by April 15th. If check payment is not received by this date, your reseervation will be cancelled. You will receive directions for payment in your email confirmation.

Consent*

My teen and I understand and agree to abide by this event's policies.

POLICIES
Teens agree to stay in the restaurant area of Dave & Busters and only leave when an approved adult picks them up, with the group as they return to the convention area, or under a parent-approved arrangement.

A BHC Teen Waiver is required - please complete the online form at https://birminghamhomeschoolers.com/terms-of-service/bhc-teen-waiver/

Parents should watch their cell phones and/or the Whova app for text notifications. If a parent is contacted by the BHC Teen Coordinator, please exit your workshop/session/lunch and come to care for your teen immediately.

Photos and/or videos may be taken during the Teen Social. If your student's image should not be shared publicly, please provide a signed note when your teen joins the group. Otherwise, you are giving us permission to capture your child's image via photo/video and are waiving any rights to compensation or ownership.

Teen Social Registration Ages 13-18

Parent/Guardian Information

Additional Information

Registration

Teen 1

Teen 2

Teen 3

Teen 4

Adult Options

Confirmation & Payment