Operation Arctic at Liberty Baptist Church

Family Information

Parent/Guardian First Name

Parent/Guardian Last Name

Address

Street

Street 2

City

State/Province

Postal Code

Primary Phone

Alternate Phone

Relationship to Student

Phone Number

Do you have a home church?

Who is not allowed to pick up your child?

Which days do you plan for your child to attend Vacation Bible school with us?

Wed. June 27th

Thur June 28th

Fri June 29th

Emergency Contact

Medical release form for your child Medical Release I give permission for my registered child to participate in all activities at the Liberty Baptist Church Vacation Bible School, and authorize any medical treatment in my absence, for the well-being of my child, in case of an emergency. I agree to hold harmless Liberty Baptist Church, and any and all volunteers of the Vacation Bible School, exclusive of negligence, from any injury or sickness which occurs during this program. This authorization shall remain in full force and effect unless otherwise revoked in writing. A photostatic copy of this authorization shall be as effective as the one containing my original signature.

Signature

Register for VBS

at West Salem Baptist Church

Family Information

Address

Student Information