Experience Day Registration Experience Day RegistrationPlease enable JavaScript in your browser to complete this form.Student InfoStudent Name *FirstLastGender *MaleFemaleDate of Birth *MM123456789101112/DD12345678910111213141516171819202122232425262728293031/YYYY202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Year of High School Graduation *2017201820192020202120222023OtherAddress *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeCell Phone Number *Email *Home Church (name/city) *T-Shirt Size *SmallMediumLargeX-LargeXXLInfo about your visitWill you be with us for the full Experience, or only on Monday? *I'll be there both Sunday and MondayI'll only be there on MondayAre you planning to stay in the BICS dorms on Sunday night? *YesNoWe're glad you'll be able to stay with us in the dorms! We'll be in touch about where you'll be staying and what you should bring. Are you attending Experience Day with your parent/guardian? *YesNoUnfortunately we're unable to provide housing for parents, but we'll be glad to point you in the direction of some affordable options.Do you have any food allergies? *YesNoWhat are your food allergies? *Who else is joining you for Experience Day?e.g. friend(s), youth pastor, etc.Parent/Guardian InfoParent/Guardian Name *FirstLastParent/Guardian Email *Parent/Guardian Phone *Parent/Guardian Permission If your parent/guardian is not attending with you we need written permission from he/she to participate in Experience Day. Please download this permission form and submit the completed/signed form below. You may also email this form to info@berkshireinstitute.org, but it must be submitted prior to attending Experience Day. Permission Form UploadAdditional CommentsMessageSubmit