LYM in Real Life Waiver

1
Parent/Guardian Name* This field is required.
First Name
Last Name
2
Parent Email* This field is required.
example@example.com
3
Parent Phone Number* This field is required.
Area Code
Phone Number
4
Student Name* This field is required.
First Name
Last Name
5
Student Current Grade* This field is required.
Grade 6
Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
Grade 12+
6
Student Birthdate
Date
Year
Month
Day
7
Student Mailing AddressWe like to send mail, because students like to receive mail. So please add your mailing address for birthday cards and more!
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
8
Grade 9 & Grade 10We know that some students in grade 9 are closer in friendship to those in grade 10, and we know some in grade 10 are closer in friendship to those in grade 9. Since Lytehouse is now divided by junior high and senior high, we are providing the option for students in these grades to determine if they'd prefer to attend with the other grade (for example: a student in grade 9 could decide with parental permission to attend the senior high Lytehouse in the grade 10 group). If they decide to do this, they'll need to continue attending with that grade for the full year. Please indicate below if your student is in grade 9 or 10 and would like to attend with the other grade group.This is not an option for other grades.
9
Parent: New Regulations* This field is required.As a parent, have you reviewed the video of Pastor Crystal describing the regulations required for students in the space and had a conversation with your student about the importance of following these? This video is available on lytehouseyouth.com/lym
YESNO
10
Student: New Regulations* This field is required.As a student, have you reviewed the video of Pastor Crystal describing the regulations required for everyone in the space and understand the importance of following these? This video is available on lytehouseyouth.com/lym
YESNO
11
Bubble MembersFeel free to include a list of your Students approved bubble members. Where it is suitable, we will allow bubbled students to sit together.
12
Student InformationIs there anything you'd like to discuss with us, or have other information about your student that you'd like us to be aware of? (allergies, other needs, etc)
Huge
Large
Normal
Small
Ok
Ok
13
I acknowledge that my student has to preregister for each individual event to attend. Text updates are sent weekly, parents text: lytehouse to 709 701 3336
YESNO
14
Parent SignatureAs the parent/guardian of the student noted in this form, I am providing my signature as permission for them to attend in-person gatherings at Lytehouse Youth (a ministry of Bethesda Pentecostal Church). I acknowledge that there are regulations that they're expected to follow and the importance of my partnering with Lytehouse in ensuring my student is compliant with these regulations. I also acknowledge that if my student is exhibiting symptoms of sickness as outlined on the Government of NL COVID-19 self-assessment tool, that they cannot attend while exhibiting these symptoms. If my student isn't compliant or is negligent in adhering to the rules and social distancing guidelines, or exhibits signs of illness, I may be called and asked to pick my student up early.
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