Clearview Baptist Church - Southaven

Child's Name

Street Address

Apt #

City

State

Zip/Postal Code

Phone Number

Child's Age

Parent/Guardian's Name

Present Church Attending

Medical conditions or allergies we should know about?

Transportation TO VBS - Buses run in Horn Lake, Southaven & Olive Branch only
Please PICK UP my child on the bus
I will bring my child

Transportation FROM VBS - Buses run in Horn Lake, Southaven & Olive Branch only
Please bring my child HOME on the bus
I will pick up my child

Clearview Baptist Church Liability Waiver

In consideration of your accepting my child for participation in Vacation Bible School at the Clearview Baptist Church, I hereby, for myself, my heirs, executors, and administrators, waive and release any and all rights and claims for damages that I may have against Clearview Baptist Church and its agents, employees, representatives, successors, and assigns for any and all injuries suffered by my child that arise out of the Vacation Bible School sponsored by Clearview Baptist Church. This would include any travel involved in the above named programs. I warrant that I have the right to authorized foregoing and do hereby agree to hold Clearview Baptist Church and associated parties, harmless of and from any and all liability of whatever nature which may arise out of or result from such participation. For the consideration stated above, I further agree that in the event that my child should make any claim against Clearview Baptist Church and associated parties for damages arising out of participation in Vacation Bible School, I will personally indemnify, defend, and hold harmless the organization and its agents, employees, representatives, successors, and assigns against any and all loss and damage occasioned thereby, including attorney’s fees. I have read and understand this agreement and have willingly checked the box below as evidence of my acceptance of the conditions contained herein.

Please Select
By submitting this form I testify that I have read and understand this agreement and have willingly checked this box in lieu of my signature.

Fill out the registration form below for our fun-filled, western-themed Vacation Bible School!! If you have any questions, please contact us at 662.349.2233

Vacation Bible School, June 30 - July 3, 2025
6pm - 8pm
Ages K4 - 12 years old

Register Your Child Today!

Please complete all information.

Clearview Baptist Church Liability Waiver

662-349-2233

clearviewbaptist@hotmail.com

3345 Goodman Rd E, Southaven, MS 38672

Fill out the registration form below for our fun-filled, western-themed Vacation Bible School!! If you have any questions, please contact us at 662.349.2233

Vacation Bible School, June 30 - July 3, 20256pm - 8pmAges K4 - 12 years old

Register Your Child Today!

Please complete all information.

Clearview Baptist Church Liability Waiver

662-349-2233

clearviewbaptist@hotmail.com

3345 Goodman Rd E, Southaven, MS 38672

Vacation Bible School, June 30 - July 3, 2025
6pm - 8pm
Ages K4 - 12 years old