Parent Name:                          Parent Name: 


  

 Child Name:                             Child Name:                              Child Name:

 Birthday:                                   Birthday:                                   Birthday:


 Male          Female                   Male          Female                   Male          Female

                                                                                             

 

 Grade:                                       Grade:                                      Grade:



 Address: 



City:



 State, Zip:



Emergency Phone #



Email:



Date:



 FREE BUS RIDES AVAILABLE IN THE RICHMOND AND CENTERVILLE AREA!!!


 My child(ren) require bus pick up:   Yes      No

                                                                   

  

 

 I understand that Victory Baptist Church exists to help people know Jesus Christ through preaching and applying the teachings of the Holy Bible.

By clicking the SUBMIT button below, I acknowledge that I understand the above purpose and program of Victory Baptist Church, and that the child(ren) listed above have my permission to ride the bus and participate in the program of Victory Baptist Church.*

By clicking the SUBMIT button below, I also give permission for my child(ren) to be photographed for Master Clubs purposes** and absolve Victory Baptist Church and its staff of any liability in the event of any injury to my child(ren).

By clicking the SUBMIT button I also acknowledge that if any emergency regarding my child is to occur, that every measure will be used to contact me and that in the event that Victory Baptist Church staff are not able to reach me, I give my permission for Victory Baptist Church to take steps to ensure the health of my child(ren) until such time as I can be reached.


*No child(ren) will be baptized without a further conversation with and specific permission from, the child's legal parent or guardian.


**No photos of a child or children will be used for promotional or public use without a further conversation and specific permission from, the child's legal parent or guardian.