Youth Contact Info

Please complete the following form so that we can stay connected with you and know how best to serve your teen! Thank you!

PARENT | GUARDIAN INFO

Please complete the following info so we know how best to communicate with you!

PARENT | GUARDIAN #1 NAME

First Last

PARENT | GUARDIAN #1 PHONE

PARENT | GUARDIAN #1 EMAIL

PARENT | GUARDIAN #2 NAME

First Last

PARENT | GUARDIAN #2 PHONE

PARENT | GUARDIAN #2 EMAIL

STUDENT INFO

STUDENT NAME

First Last

BIRTHDAY

GRADE

Please enter a number from 5 to 12.

If submitting during the summer, please put the grade they are entering in September.

STUDENT PHONE (optional)

This is used solely for communication within a group setting of students and leaders to share event info/reminders, prayer requests, and scripture/devotional encouragements. No student will be contacted privately by a leader without specific permission from a parent or guardian.

Please list any medical and/or food allergies here:

MINOR CONSENT FORM

I agree to the consent form below.

MINOR PARTICIPATION AUTHORIZATION & CONSENT TO EMERGENCY MEDICAL TREATMENT FORM

PLEASE NOTE: By clicking above, you are agreeing to this form and all the information within. If you’d like a hard copy of this form, please see our website or one of the youth leaders.

I, the undersigned, certify that I am the parent or legal guardian of the child (hereafter referred to as “minor child”) listed on this sheet.

I hereby give my consent to have my minor child participate in the activities of Trinity Alliance Church Youth Group (hereafter “the activity”).

I recognize that there may be risks involved in participating in this activity and hereby assume all risk of injury, harm, damage, or death to my minor child in connection with his/her participation in this activity.

To the fullest extent permitted by law, I release Trinity Alliance Church, its trustees, officers, directors, employees, agents and representatives from any injury, harm, damage or death which may occur to my minor child while participating in the activity and agree to save and hold harmless Trinity Alliance Church, its trustees, officers, directors, employees, agents and representatives from any claims arising out of my minor child’s participation in the activity.

Further, being the parent or legal guardian of the minor child, I do consent to any medical, surgical, x-ray, anesthetic, or dental treatment that may be deemed necessary for my minor child. I understand that efforts will be made to contact me prior to treatment but, in the event I cannot be reached in an emergency, I give permission to the activity leader to make the decisions necessary for treatment. Should there be no activity leader available, I give permission to the attending physician to treat my minor child. As parent or legal guardian, I understand that I am responsible for the health care decisions of my minor child and agree that my insurance plan is the primary plan to pay for the medical, dental, or hospital care or treatment that is given to my minor child. Any insurance policy of the church or organization sponsoring this event will be used as the secondary coverage.

Executed the day of form submission.