Victory Baptist Church of Benton - Individual Registration

Parent / Guardian (Adult) Information

Parent Info

✕

First Name

Last Name

Email

Phone Number

Add another person

Attendee Information

Is this registration for the adult listed above?

Yes

No

Child Info

✕

First Name

Last Name

Date of birth

Gender

Add another person

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.

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.

Additional Comments or Questions

Parent / Guardian (Adult) Information

Attendee Information

SERVICE TIMES

CONTACT

FOLLOW US