Youth Permission Form
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Youth Information and Permission Form Child’s full name: Date completed: Current grade in school:
Birth date: School attended:
Name of Parent/Guardian: Home address:
Home phone: Emergency contact (in case you cannot be reached): Name / relation to child: Phone: Is there anyone your child should not be released to? Health information (Please list any allergies, medications, health concerns, etc.):
Health insurance carrier:
Policy no.:
Permission to participate in Church activities: I give my permission for my child , to participate in all activities sponsored by Whitesburg Baptist Church. I understand that all activities will have adult supervision and I will receive advance notice if any activities in which my child will go off church property. Signed: Date:
1
Birth date: School attended:
Name of Parent/Guardian: Home address:
Home phone: Emergency contact (in case you cannot be reached): Name / relation to child: Phone: Is there anyone your child should not be released to? Health information (Please list any allergies, medications, health concerns, etc.):
Health insurance carrier:
Policy no.:
Permission to participate in Church activities: I give my permission for my child , to participate in all activities sponsored by Whitesburg Baptist Church. I understand that all activities will have adult supervision and I will receive advance notice if any activities in which my child will go off church property. Signed: Date:
1
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