Malibu Jacks | The Worship Room

Malibu Jack's Outing

We are so excited to be able to offer this fun outing to our church youth! Please fill out this brief permission/information form so we can make appropriate accommodations for all youth to attend.

Name (Required)

Email Address (Required)

Your Phone Number (Required)

Pleas list the names of all children attending:

Plist list each child's name separated by a comma.

Do you give your child(ren) permission to attend the Malibu Jack's outing with The Worship Room church on June 14th, 2025? (Required)

Yes

Emergency Contact (Required)

In the event of an emergency, who do we contact? Phone number?

Allergies or Medical Info (Required)

Do you give your child permission to ride the church van or with other adults to/from Malibu Jack's on June 14th, 2025? (Required)

Yes

I will transport my child to/from

You (parent) and child both agree that the child will act appropriately in a manner representing themselves, the church, but most importantly Jesus. They agree to follow all rules/expectations set forth by the leaders of The Worship Room church. (Required)

Yes, I agree

No, I do not agree

I understand that my child will be responsible for paying $10 by June 11th towards the entry fee and will be responsible for their own lunch cost. If there is any financial concern please let us know. (Required)

Yes

We need assistance with the cost

Lets have some fun!

We are excited to be able to experience this fun outing with our church family. If you have any questions please reach out to the youth leader Alex Martin at (270) 572-9788 or email the church at TheWorshipRoom.Ky@gmail.com.

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The Worship Room

106 S Public Square
Greensburg KY 42743

(270) 405-2005

TheWorshipRoom.KY@gmail.com

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