Kings Dominion Trip 2025 • Battlefield Baptist Church

Date & Time

May 3, 2025 8:30 AM - 10:00 PM

Type

Price

Quantity

Standard

Price
$45.00

Quantity

Standard 0

First Name *

Tip: Child's First Name

Last Name *

Tip: Child's Last Name

Age *

School Grade *

Phone Number *

Email Address *

Emergency Contact *

Emergency Contact Phone Number *

Medical Waiver

By signing below, I give permission for my child to attend Kings Dominion (16000 Theme Park Way, Doswell, VA 23047) on May 3, 2025, and to participate in all activities. I waive all claims against Battlefield Baptist Church and/or leadership, including volunteers, of any injuries that may be sustained by my said minor child and agree to indemnify and hold the church and workers free and blameless from any liability, costs, and damages therefore. I hereby consent to and grant the leadership of Battlefield Baptist Church full rights and authority to act for me in any manner pertaining to the care and control of the said minor child named above during this event. If for any reason this child needs to leave early, I accept responsibility to be available to answer any communication from the church or volunteers and arrange for the child's transportation home.

Electronic Parent Signature *

Tip: Parent's Full Name

Date *

Parent's Name *

Tip: First and Last Name

Is participant covered by personal/family medical insurance? *

Yes

If Yes, name of insurer: *

Policy or group number: *

List allergies, if any:

List medications, if any:

Does the child have any special problems, conditions, or restrictions? *

Yes

If Yes, please explain: *

Please list any special instructions: