Youth Group Permission Form and Emergency Contact Submission

Name of Participant:*

First

Last

Address*

Street Address City State / Province / Region Postal / Zip Code

Phone*

Date of Birth

EMERGENCY CONTACT INFORMATION

Parent/Guardian*

First

Last

P/G Address*

Street Address City State / Province / Region Postal / Zip Code

P/G Phone*

Chronic Conditions (i.e. Allergies, Epilepsy, diabetes, ETC.)

Medications

Medical Insurance & Policy Number

Family Physician

First

Last

Physician Phone

CODE OF CONDUCT FOR ALL YOUTH ACTIVITIES

Participants must stay and participate in the entire event. Participants may not leave the premises unless accompanied by an adult leader, parent, or legal guardian.
If staying in overnight accommodations, participants will adhere to all rules of the facilities and any other rules set forth by the adult in charge of the event.
The possession or use of alcohol, tobacco, drugs, or weapons of any kind is not permitted.
Participants must adhere to any and all directions of the activities staff and represent Good Shepherd church in a Christian manner.
Participants must respect the rights and property of others. Damage to or defacing of property will be the financial responsibility of the participant involved and the participant's parents/legal guardians.
Failure to abide by this Code of Conduct may result in a request to parents/guardians to transport the offending participant from the premises, and the parents/guardians shall immediately comply with the request.

Participant Signature*

Parent/Legal Guardian's Signature*

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Good Shepherd Lutheran Church