2019-2020 Activate Release Form

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Three Rivers Bible Church
220 N. Erie St.
Three Rivers, MI 49093
269-278-2795
pastorjordan@threeriversbiblechurch.org

Student's Last Name *

First name of Student(s) *You may include all siblings from the same home on this one form. *

Cell phone number of student (if applicable)

Address including city, state, and zip. *

Emergency Contact Name(s) and Phone Number(s) *

Please list any dietary restrictions

Are there any other concerns we should be aware of?

Parents (or students age 18 and above) please sign below by typing your full name in the blank provided.

By signing this form, I permit my child to participate in youth activities with Three Rivers Bible Church. I agree to release Three Rivers Bible Church from liability while my child participates in these activities. I permit my child to be taught lessons from the Bible, and to ride in the church vans when necessary. *

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