Youth Emergency Contact Form
Please fill out this form so that we are best able to serve your children while they are attending youth group.
Students Name
*
Date of Birth
*
Grade
*
Students Email
*
Students Phone
*
Address
*
Emergency Contact Information
Parent/Legal Guardian 1
*
Relationship
*
Primary Phone Number
*
Primary Email
*
Parent/Legal Guardian 2
Relationship
Primary Phone Number
Primary Email
Electronically Sign and Date
I/We confirm that all information provided above is relevant and true to our student. I/We understand that we will be contacted in the event of an injury. I/We understand that our contact information may be used as part of an email or text list to receive updates about upcoming youth events and newsletters.
*
Please select all that apply.
Yes
No
Signature of Parent/Guardian 1
*
Signature of Parent/Guardian 2
Date
*
Submit
Description
Please fill out this form so that we are best able to serve your children while they are attending youth group.
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