Summer Camp 2017 Registration

Name *
Name
Name of the student attending event.
Address *
Address
Phone Number *
Phone Number
List any allergies
Let us know who invited you by the student’s first and last name.
Let us know if you are currently going somewhere or not any where at the moment.
Waiver
By pressing submit, you as a parent or guardian, authorize First Baptist Church of De Queen to allow your son/daughter to participate in all Youth activities in either church facilities or off-property locations. I also release my child to be picked up and transported to the church and/or off properties. Please be aware that we will not allow fighting, swearing, disruptions or public displays of affection. Each individual must obey and respect the youth leaders and counselors. Breaking these rules is grounds for your son /daughter to be sent home immediately.