Danvers Baptist Church

Summer Blast 2024

Ages: K4-5th Grade

Child's Information
Parent/Guardian Information
I give consent for photographs/videos of the children named above taken during this program to be used for promotional purposes of Danvers Baptist Church.
Permission to Attend:  I give permission for the children named above to attend and participate in all activities of SUMMER BLAST at Danvers Baptist Church and our neighboring property at 105 N West St, Danvers.
Medical Release:  I authorize the executive staff or designated medical professionals to administer emergency medical assistance in the event that I cannot be reached. I understand that the SUMMER BLAST staff will contact emergency services in the event of a significant injury and that all expenses for such emergency services will be paid by me, the parent or guardian. I further understand that in signing this form, I release and hold harmless Danvers Baptist Church, its pastor, directors, officers, employees, and any volunteers from any liability, past or future, fully and completely.

Danvers Baptist Church
104 W. Columbia | PO Box 375 | Danvers, IL 61732 | 309.963.4627