Membership Application Form

YOUTH CONSENT FORM

FRIDAYS, 6:30 pm to 9:00 pm
Full Name:*

First NameLast Name
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Youth Contact Phone Number:*
Mobile #Home #
Email:
example@example.com
Birth Date:*

MonthDayYear
Age:*
Current Grade level:*
Allergies or other medical conditions:*
In case of emergency, contact:*

First NameLast Name
Emergency Phone No.:*
Relationship to Youth:*
I, First Name Last Name am the above-named youth's parent (or official guardian) and give my permission and consent for my child to participate in Friday night youth.

Yes! By selecting this box you consent to allow your child to be contacted through the Band App for important notifications such as cancellations, updates, events and virtual consent forms. This app does not allow your child to contact leaders or other youth individually and is only used for the purposes of sending out information to keep your child updated.

In addition, I undertake and agree to indemnify and hold blameless the Ministry Staff, Volunteers, Lighthouse Church of God, its Pastors, Trustees and Board of Elders from and against any loss, damage or injury suffered by the participant as a result of being part of the activities of Lighthouse Church of God, as well as any medical treatment authorized by the supervising individuals representing the church. This consent and authorization is effective when participating in events of Lighthouse Church of God, on or off-site.
Date*

MonthDayYear
Today's Date
ELECTRONIC Parent's Signature*
Should be Empty:

YOUTH CONSENT FORM