Student Ministries T h e Ro c k & Wo r s h i p Ro a d s h ow Thursday, November 3rd Concert Registration Form All forms are due by Saturday, October 29th
____________________________________________________________________ Name ____________________________________________________________________ Address ____________________________________________________________________ City ____________________________________________________________________ Phone
Cost : Free Student Ministries will pay for your ticket. Bring your own money for dinner & purchases.
Meet at Church by 4:00 pm.
____________________________________________________________________ Emergency Contact
As parent or guardian of the student listed above, I give permission for him/her to attend this trip. I authorize the leaders for Essexville Baptist Community Church to represent me in the need for medical treatment. _____________________________________________________________| ___________________________________________ Parent/Guardian Signature Date _____________________________________________________________|____________________________________________ Insurance Carrier Policy #
Invite a friend! Everyone does need a signed permission form. Additional forms are available at the website at www.essexvillebaptist.com. This is the concert of the fall! Student Ministries will pay the $10 cost for the concert as well as provide transportation for Middle and High School Students. The church van will leave at 4:00 pm. to the Dow Events Center in Saginaw.
For questions contact: Shirley Reid 989.964.8827 firstname.lastname@example.org
Or Rev. Richard Kinnamon Essexville Baptist Community Church 1001 Main St Essexville, MI 48732 989.892.9892 email@example.com