Altered Youth Activity Consent Form
First Name
*
Last Name
*
Mobile Number
*
Youth | Email Address
*
Tip: Can be a parent's if the student does not have one
Date of Birth
*
Home Address
Father's First Name
Father's Last Name
Father's Email Address
Father's Mobile Number
Mother's First Name
Mother's Last Name
Mother's Email Address
Mother's Mobile Number
Medical Information
List Any Medical Conditions We Should Know About:
Family Doctor
Doctor's Phone Number
Insurance Company
Policy Number
Consent & Certification
I give my consent
*
By completing this document, electronically, being the parent or legal guardian of the youth named above, do herby consent to the participation of my youth in all the scheduled youth activities of Friends Baptist Church. This includes any supervised activities customarily associated with it's youth group, including teen camp and overnight weekend youth trips. If I wish to revoke this consent for any reason, I will promptly notify the youth leader in writing.
Signature (Type the full name of the parent/guardian giving consent)
*
Submit
