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Participant Registration

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Registro en Español

Locust Grove Baptist Church

Location

171 County Lake Road

New Market, AL 35761

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Contact Linda Hill:

256-379-2813

lindahill@locustgrove.com

First, Tell Us About Yourself:

Parent Information

First Name

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Last Name

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Address 1

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City

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State/Province

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ZIP/Postal Code

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Contact Phone 1

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Contact Phone 2

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Home Church Affiliation

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PLEASE FILL OUT BOTH PAGES OF THIS FORM. PAGE 1 IS FOR PARENT INFORMATION AND PAGE 2 IS FOR THE CHILD'S INFORMATION.

By registering my child, I grant permission to Locust Grove Baptist Church to use the image of my minor child. Such use includes the display or publication of photographs and/or video for use in brochures, newsletters, videos, or on the church's website or social media pages. I agree that these images may be used by LGBC for a variety of purposes and that these images may be used without further notifying me. I understand that my child's last name will not be used with any of these images. This agreement is good until I rescind it in writing.

Click here for your FREE Friends With God Kids Activity Pack

By checking the box you will be emailed your Free Friends With God Kids Activity Pack.

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Tell Us About Your Participant

First Name

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Last Name

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Grade Leaving

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Gender

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Date Of Birth

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Allergies/Medical Concerns

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Emergency Contact Name

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Emergency Contact Phone

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Does your child attend Locust Grove Daycare or Summer Care?

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PLEASE FILL OUT BOTH PAGES OF THIS FORM. PAGE 1 IS FOR PARENT INFORMATION AND PAGE 2 IS FOR THE CHILD'S INFORMATION.

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