Dear Parents/Guardian,
In the day and age in which we live, and at the point in life your child has reached, the decisions he or she makes will greatly mold and shape who they will become in life. Much of the difficulties students will face will be as a result of what they do with their extra-curricular time and with whom they spend it.
BLAST is a fantastic program that attempts to reach the hearts of students by establishing and building upon relationships, mentoring, activities, FRIENDS, FUN and most importantly, the FAITH that students need in order to deal with the choices of life that lie ahead. BLAST does not teach religion but presents and challenges students with truth directly from the Bible. BLAST at Liberty Middle school, meets immediately after school is dismissed and lasts until 4:30 pm.
All students will be released from BLAST as parent or guardian pick up or for transport home by van or bus provided by Bible Baptist Temple. While it is our goal to offer transportation for every student, due to time constraints, van transport home may be limited in certain outlying areas. You will be contacted if this is the case.
· Start date is 4/10/26.
· PLEASE COMPLETE AND HAVE YOUR STUDENT RETURN THIS FORM TO THE SCHOOL OFFICE AS SOON AS POSSIBLE.
· IF YOU HAVE ANY QUESTIONS PLEASE CONTACT BRANDON-304-692-0262.
This permission slip is good for the entire 2025/2026 school year. Even if your child is unable to attend right away, you are strongly encouraged to register them now so that at any time during the school year, if your student decides to attend, he or she will already be signed up. Also, simply by signing and returning this form, you will be registered to receive special announcements for BLAST sponsored youth activities and events, MAKING THE STUDENT ELIGIBLE FOR FREE TICKETS OR SPECIAL DISCOUNTS ON UPCOMING ACTIVITIES AND YOUTH EVENTS. You may also find information and updates on the BLAST Facebook page.
By signing below, I certify that my child is able and permitted to participate in all activities, including games, snacks and food unless otherwise indicated. In addition, my child has my permission to ride any program provided mode of transportation such as van, bus, etc. If in an emergency I cannot be reached within a reasonable period of time, I hereby authorize any adult sponsor or agent of BLAST to make emergency medical decisions for my child.
Please note that neither these materials or this after school program is sponsored nor endorsed by the Board of Education of Harrison County, the Harrison County Public Schools, or any agents thereof. I do hereby agree to hold BLAST and Bible Baptist Temple and its agents, sponsors and employees, harmless from any and all liability, including illnesses such as COVID-19. I expressly agree that this release, waiver and indemnity agreement is intended to be broad and inclusive as permitted by the laws of the State of West Virginia.
BLAST may, from time to time, document the activities of the program with photos or videos. By signing below, you hereby assign and grant to BLAST, its subsidiaries, sponsors and successors, and assign the unqualified right to the ownership, use and proceeds of all photographs or video of you and/or your minor child, without reservation or limitation, including use of photographs or video of you and/or your minor child for, but not limited to, advertising, educational and promotional purposes.
BLAST INFORMATION FORM (3/18/26)
Student Name: __________________________________________ Age: ______
Grade: ______
Birthday: __________________
Home Address: ______________________________________________
City: ___________________________ Zip: ____________
Parent/Guardian Name #1: _____________________________________
Relationship to Student:
_____________________________
Parent/Guardian #1 Cell Phone: _________________________________
Home Phone: _____________________________________
Parent/Guardian Name #2: _____________________________________
Relationship to Student:
_____________________________
Parent/Guardian #2 Cell Phone: _________________________________
Home Phone: _____________________________________
Any Known Medical Conditions and Allergies to be aware of: ___________________________________________________________
CHOOSE ONE:
____My student will be picked up after Blast
____My student will ride the church van home (restrictions apply)
Provide VAN DROP ADDRESS IF DIFFERENT than
Home: _____________________________________
City: _____________________
By signing below of my own free will, I state and confirm that I have read and agree with the terms and conditions of this consent form and the BLAST program.
Parent / Legal Guardian Signature
______________________________________________________
Date ______________