Student Full Name:
Birthdate: (mm-dd-yyyy)
Age:
Completed Grade:

Events: :
Additioanl Event Details:

Phone Numbers:
Home:
Work:
Cell:

E-Mail Address:

Address:
City, State Zip: ,

**Allergies/Comments:
(Please add N/A if you have no comments)

Parent/Guardian:
Home Church:


Brought by:
Phone Number:

Waiver of Responsibility:
I, hereby waive any and all responsibility on the part of INDEPENDENT BIBLE FELLOWSHIP CHURCH or any persons involved with INDEPENDENT BIBLE FELLOWSHIP CHURCH for any and all accidents, bodily injuries, harm or loss, which occur to me or my family while being transported to and from or while attending events and activities at Independent Bible Fellowship Church.

For more information: Contact the Church office at 302-398-3411.

I further waive any financial responsibility to INDEPENDENT BIBLE FELLOWSHIP CHURCH or any persons involved with INDEPENDENT BIBLE FELLOWSHIP CHURCH. If any medical expense is incurred for me or my family, it shall be covered by our family personally or by our family health insurance coverage.

We may photograph all the participants at the events and activities. These photographs are displayed on the church bulletin board and/or the church website. By checking the box you are providing your consent for your child to be photographed and those photos to be displayed, including on the website.

6797 Milford-Harrington Hwy, Harrington, DE 19952 (302) 398-3411