Easter Box Registration

Celebrate new life and hope this Easter. Sign up below and we'll prepare a box so your family can share a full, joyful meal together this spring.

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Family & guardian information

Fields marked * are required.

First Name *

Last Name *

Number in household *

Home Address *

Email Address *

Home Phone

Cell Phone *

Agreement of Release & Waiver of Liability

In signing, I agree to the following: I am requesting an Easter Box provided by Be The Light Inc. I recognize that Be The Light Inc. cannot meet the dietary restrictions of all families. I acknowledge that Be The Light Inc. will not be held responsible for any food allergies my family has and that no accommodations for such allergies will be made. I understand, and am fully aware, that the food items contained in the Easter Box may vary based on supplies available.

I hereby voluntarily waive any claim I have against Be The Light Inc. and their agents for any illness or injuries that may arise as a result of participating in the Easter Box program.

I consent to the above terms and conditions. *

Signature *

Date *

Be The Light Inc., PO Box 312, Wamego, KS 66547 · 785-706-1491