Victory Baptist Church of Benton - Individual Registration

Parent / Guardian (Adult) Information

Parent Info

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First Name

Last Name

Email

Phone Number

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Attendee Information

Is this registration for the adult listed above?

Yes

No

Child Info

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First Name

Last Name

Date of birth

Gender

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Church Information

Church Name

Church City, State

I give my child (dependent) permission to attend Teen Week. In the event that I cannot be reached at the provided phone number, I give the Victory Baptist Church staff permission to act on my behalf for my child (dependent), should they need medical attention. Furthermore, I will not hold Victory Baptist Church responsible for any injuries or illness, including COVID-19, that could occur or be contracted during the Teen Week including transportation to and from Victory Baptist Church.

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Parent / Guardian (Adult) Information

Attendee Information

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