In addition to filling out the form below, please download and print both of the forms found above.

LBC Day Camp Registration Form

Please fill out all information
(or maternal legal guardian)
(or paternal legal guardian)

Emergency Contact #1

Emergency Contact #2

Medical Information

This agreement releases Lonoke Baptist Church from all liability relating to injuries that may occur during our Fish Splash Day Camp on the church property, on the church bus traveling to and from the AWA campground and on the AWA campground. By signing this agreement, I agree to hold Lonoke Baptist Church entirely free from any liability, including financial responsibility for injuries incurred, regardless of whether injuries are caused by negligence.

I also acknowledge the risks involved in the Day Camp activities. These include but are not limited to bouncy houses, fishing, playing games and traveling from activity to activity. I swear that I and my child are participating voluntarily, and that all risks have been made clear to me. Additionally, my child does not have any conditions that will increase his/her likelihood of experiencing injuries while engaging in these activities.

By signing below, I forfeit all right to bring a suit agains Lonoke Baptist Church for any reason. I will also make every effort to obey safety precautions as listed in writing and as explained to me verbally. I will ask for clarification when needed.

I, the legal guardian to the below listed participant, fully understand and agree to the above terms.

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