Locust Valley Chapel 5936 Locust Valley Road, Coopersburg, PA 18036
OFFICE: (610) 282-3881 FAX: (610) 282-6124
www.locustvalleychapel.org Email: locustvalleychapel@gmail.com
Parental/Guardian Consent Form for Activities (Blanket Permission)
Parents/guardians please print this form, sign, date, and return to Pastor Rick or the church office:
Signature:________________________________________
Date: ______________________