Hearts on Fire

Special Note: Please fill out one form per student.

Student First name

Student Last name

Student Phone

Parent First name

Parent Last name

Parent Phone

Student T-Shirt Size

I give persmission for my teen to ride the bus and be under the leadership of the Beech Park Chaperons.

I consent to allow my teen photo to be used for chuch promotional video and social media.

I, parent/guardian, of the above named teen consent to my teen participating with Beech Park Baptist Church at Hearts on Fire conference and the transportation provided on November 22-23. I agree not to hold Beech Park Baptist Church liable or responsible for any lost possessions, loss of life, or injury sustained by my teen arising in connection with their participation in the travel or activities.

Parent Signature

Thanks for registering to our event!