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5555 CR 29, Auburn
260-925-2006

Vacation Bible School High Seas Expedition

Join us for a High Seas Expedition!
Dates: Monday, June 21th - Friday, June 25th
Time: 9:00 a.m. – 12:00 Noon (Join us for a picnic at Noon on Friday for Face Painting, Clowns, Balloon Art and FUN! (Kids lunch provided.)
For: 4 year olds – 5th graders (in fall of 2010)
How to Help: Bring the neighborhood kids, volunteer to help, be a team leader, get excited and spread the word! If you have helped before or are interested in helping for the first time please contact Amy Hardy at the church office 260-925-2006 ext.147.

Online Registration:

Student's Name

Date of Birth Age:

Boy Girl

Grade student will enter this fall 2010

(If your child is attending ELM or Beyond the Bell Day Camp this summer, they must check-in with ELM or Day Camp and will be brought to VBS as a group.) My child is in ELM Beyond the Bell Day Camper

Street Address

City, State, Zip

Home Phone

email address

Mother's Name

Mother's Work Phone

Mother's Cell Phone

Father's Name

Father's Work Phone

Father's Cell Phone

Persons are permitted to pick up child:

Food Allergies

Other Allergies or
medical conditions

I, the undersigned parent or guardian of, a minor, do hereby authorize his/her participation in activities at Lakewood Park Baptist Church. In consideration of Lakewood Park Baptist Church providing these activities, I, on behalf of myself and the other parents and guardians of the minor, do hereby release Lakewood Park Baptist Church, its officers, employees, agents, and members of the Board of Elders from all claims and causes of action by reason of any injury which may be sustained as a result of these church activities, whether on the church premises or on the way to and from these activities. I agree to direct my child to cooperate and to conform with directions and instructions of personnel of the organization in charge of these activities. This authorization will remain effective until June 28, 2010, unless sooner revoked in writing and delivered to Lakewood Park Baptist Church.

By submitting this form, you agree to the above statement without signing the written form.