Victory Baptist Church of Benton - Individual Registration

Parent / Guardian Information

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First Name

Last Name

Email

Phone Number

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Attendee Information

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First Name

Last Name

Email

Date of birth

Gender

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Church Information

Church Name

Church City, State

I give my child (dependent) permission to attend Blessed Hope Youth Conference. 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 Blessed Hope Youth Conference.

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