ActivateKC Signup Form

Join us for a fun day out! ActivateKC is located in Overland Park, KS and has custom game rooms for all ages. A waiver must be filled out for each student. You will receive an email asking you to fill out the waiver. It is very important that you respond in a timely manner so we can have a smooth and easy trip.

Details:

Activate KC

June 10th, 2026

Overland Park 6900 W 119th St, Overland Park, KS 66209

Arrive at Bridge Building at 9AM

Bus leaves Bridge building at 9:15 SHARP

Arrive by 9:45am

Play from 10am-11:30

Lunch at Taco Bell/KFC from 11:45-12:45

Head back at 12:45

Arrive to Bridge by 1:10pm

Students must be picked up by 1:30PM

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Email

Parent/Guardian Phone

Zip Code

Please provide the Zip Code of where you and your student(s) live.

Parent/Guardian Primary Language

English

Spanish

Other

Would you like to add another Parent/Guardian to this form?

Yes

How many students would you like to add to this form?

If you have more than 3 students that you'd like to be considered for this program, please email us at bridge.leadership2k@gmail.com

Student #1 (S1)

S1 First Name

S1 Last Name

S1 Grade

S1 School

S1 Date of Birth

Month

Day

Year

S1 Primary Language

English

Spanish

Other

S1 Tee Shirt Size

Adult sizes.

Does S1 have an IEP (Individualized Education Program)?

If yes, please describe the IEP and your student's needs.

S1: Please list any accommodations or special needs your student may need in order to participate.

S1: Please list any known health conditions that your student has. This will ensure that we are prepared for any and all emergencies related to your student.

For example: asthma, epilepsy, diabetes, etc.

S1: Please list any medications that your student currently takes.

S1: Please list any known allergies your student has.

S1: Please list the preferred hospital for your student in the case of an emergency.

S1: Is there anything else we need to know about your student regarding their medical or safety needs?

ActivateKC Signup Form

Student #1 (S1)

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