Register for Shocks, Cops, Fire & Kids 2019

Program Details

When:	Saturday, September 28, 2019 Registration starts at 9:00 AM Event runs from 10:30 AM to 3:30 PM
Where:	Charles Koch Arena – Wichita State University – (southeast corner of 21st/Hillside)
	Event cost – FREE Open for youth grades 3rd to 8th grade All attendees receive a t-shirt and lunch. Refreshments and water also provided.
Bring to event:	Click here to download the Application form. Print and fill it out, and bring it to the event.

Child

First Name

(required)

Child's First Name is required.

Last Name

(required)

Child's Last Name is required.

Grade in School 3 4 5 6 7 8 (required)

Child's Grade is required

Address

(required)

Child's Address is required.

City

(required)

Child's City is required.

State Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Marianas Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Virgin Islands Washington West Virginia Wisconsin Wyoming (required)

Child's State is required.

Postal Code

(required)

Child's Postal Code is required.

A valid 5- or 9-digit Child's Postal Code is required.

Parent

Name

(required)

Parent's Name is required.

Phone

(required)

Parent's Phone is required.

A valid 10-digit Parent's Phone is required.

Address

(required)

Parent's Address is required.

City

(required)

Parent's City is required.

State Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Marianas Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Virgin Islands Washington West Virginia Wisconsin Wyoming (required)

Parent's State is required.

Postal Code

(required)

Parent's Postal Code is required.

A valid 5- or 9-digit Parent's Postal Code is required.