Back to School Bash Registration

August 1, 2026 | 10:00am-2:00pm | Welcome!
We're excited to have your family join us. Please complete one registration per family. School supplies are intended for children in Copiah and Hinds Counties unless recipients are a member of CLBC, while supplies last.

Parent's Name

Address

Phone

Eligibility

County of Residence

Please select all that apply.

Copiah Hinds Other

Please note: School supplies are available for families residing in Copiah or Hinds County, unless a member of CLBC.

Church Information

Do you currently attend a church?

Please select one option.

Yes No

If yes, Church Name:

Children Attending

Child #1 Name

Child #1 Grade Entering

Child #1 Age

Child #1 Allergies/Medical Concerns

Child # 2 Name

Child #2 Grade Entering

Child #2 Age

Child #2 Allergies/Medical Conditions

Child #3 Name

Child #3 Grade Entering

Child #3 Age

Child #3 Allergies/Medical Conditions

Child #4 Name

Child #4 Grade Entering

Child #4 Age

Child #4 Allergies/Medical Conditions

May County Line Baptist Church use photographs or video taken during this event in church publications, on our website, or on social media?

Photo Permission

Please select one option.

Yes No

Additional Information

Anything else we should know?

Parent/Guardian Supervision Required

This is a family event. Parents or legal guardians must remain on-site and supervise their children at all times. Children may not be dropped off and left unattended. County Line Baptist Church does not provide childcare for this event.

Agreement

Please select all that apply.

I understand this event includes inflatable water slides and other outdoor activities. I do not hold CLBC responsible for any accidents that may occur while my child/children are on these inflatables. I understand that school supplies are available while supplies last and are intended for eligible families. I have read and agree to the Parent/Guardian Supervision Policy. I certify that the information provided is accurate.

Description

August 1, 2026 | 10:00am-2:00pm

Welcome!
We're excited to have your family join us. Please complete one registration per family. School supplies are intended for children in Copiah and Hinds Counties unless recipients are a member of CLBC, while supplies last.

Back to School Bash Registration

Description

Please Fix the Following