Student Life 4 Kids Registration Form (FBK)
FBC Keithville Preteen Summer Camp Event (Completed grades 3rd-6th)
Dates and Location: June 6-9, 2019 at Lakeview Retreat Center in Waxahachie, Tx;
(We will travel by chartered bus and stay three nights)
Deposit is $75 due by Jan 20. Total cost will be approximately $365.
2019 Theme: Transformed! Scripture: 2 Corinthians 5:17
Child's Name (Last, First) *
Your answer
Parent's Name and Contact # *
Your answer
Grade 2018-19 school year and Date of Birth *
Your answer
Alternate Emergency Contact Name & # *
Your answer
Allergy Information *
Your answer
T-Shirt Size
I, the legal parent or guardian, consent to my child participating in the scheduled FBC Keithville student activity and riding in provided transportation. I certify my child is physically fit and adequately prepared to participate in all recreational activities. I understand I will be notified in case of a medical emergency; however, if I cannot be reached, I authorize the calling of a doctor and providing of necessary medical services if my child is injured or becomes ill. I understand First Baptist Keithville will not be held responsible for any medical expenses or liabilities solely on the basis of this authorization.
Family Doctor and Phone # *
Your answer
Insurance Company Name and Policy # *
Your answer
Parent's Signature *
Your answer
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