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Youth Group Permission Form and Emergency Contact
Andrew King
2018-04-07T14:50:37-04:00
Youth Group Permission Form and Emergency Contact Submission
Name of Participant:
*
First
Last
Address
*
Street Address
City
State / Province / Region
Postal / Zip Code
Phone
*
Email
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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