Phone number *
Phone type Mobile Home Work Other
Household members
When adding children, please only select Pre-K if your child is 4 and will be entering K in the next school year otherwise you may leave the grade blank.
+ Add adult + Add child Have you added your children? *
Select… Yes No, please use Add Child button above
School
Select… Beford Hills Elementary Leeville Road Elementary Dearington Elementary Heritage Elementary Home School / Virtual Paul Munro Elementary ! Liberty Christian Academy Linkhorne Elementary T.C. Miller Elemntary Perrymont Elementary Robert S. Payne Elementary Sandusky Elementary Tomahawk Elementary Sheffield Elementary Boonsboro Elementary William M. Bass Elementary Desmond T Doss Christian Academy ! New Covenant Schools New Vistas School Rivermont School Timberlake Christian School Thomas Jefferson Elementary Brookville Middle Home School / Virtual ! Liberty Christian Academy Linkhorne Middle Forest Middle School Dunbar Middle Sandusky Middle Desmond T Doss Christian Academy ! New Covenant Schools New Vistas School Rivermont School Temple Christian Timberlake Christian School Rustburg Appomattox Monelison Other Amherst Middle School Home School / Virtual ! Liberty Christian Academy Amherst High School ! Brookville High ! E.C. Glass High ! Heritage High ! Jefferson Forest High Desmond T Doss Christian Academy ! New Covenant Schools New Vistas School Rivermont School Temple Christian Timberlake Christian School Virginia Episcopal School Rustburg Appomattox Liberty (Bedford) High School Other Randolph Henry Liberty University Central Virginia Community College Radford University Randolph College University of Lynchburg Virginia University of Lynchburg Sweet Briar College
Emergency Medical Release *
I am confident that the adult leaders and sponsors will take appropriate care of my child and every effort will be made for his/her safety. However, I understand that accidents do occur, and in the event of an emergency, every effort will be made to contact me. In the event of an emergency, I hereby grant permission to a representative of the Event organizer, staff member, or adult present, as agent for me, to obtain necessary medical attention in case of sickness or injury to my child as provided by the loco parentis clause of Virginia Code 54.1-2969.
Select… Accept Not Accept
Liability Release *
I, the undersigned parent/guardian of said child, do hereby release, acquit, discharge, and covenant to hold harmless and indemnify Thomas Road or affiliate for any and all claims, demands, damages, injuries, costs, suits, or causes of action, past, present, or future arising out of any accident or sickness, or treatment thereof, by me or my child while participating in any Thomas Road Baptist Church or affiliate program, event, or activity.
Select… Accept Not Accept
Photo Release *
I understand that as a participant, my child or I may be photographed or videotaped during normal ministry or event activities and these photos/videos may be used in promotional materials by TRBC staff only. I hereby grant Thomas Road permission to use of my and/or my child’s name and to use, copy, or modify such images or recordings without restriction and release the photographer and Thomas Road from all claims and liability relating to these images and recordings.
Select… Accept Not Accept
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