Youth Lake Day Permission Form

Youth Lake Day Permission Form

Completed grades 7-12 by May 2026
Student Name

First NameLast Name
Grade Last Completed May 2026
Student Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Can Your Child Swim?
Allergies or Other Important Info Regarding Student
Name of Parent/Guardian (this will be emergency contact)

First NameLast Name
Parent/Guardian Phone (this will be emergency contact)
Please enter a valid phone number.Format: (000) 000-0000.
Medical Facility You Would Like Student to Be Taken (in case of emergency)
I (parent/guardian of student named above), give permission for my child to participate in "Lake Day" with Wilsonville Baptist Church on June 13, 2026. I understand that my child will participate in sports activities, swim in the lake/pool, and various additional activities.

I give permission for Wilsonville Baptist Church representatives, staff, volunteers, or other adults to administer first aid to the student in case of accident/injury.

I agree to hold harmless, Wilsonville Baptist Church, represntatives of Wilsonville Baptist, staff, volunteers, and hosts, for any injuries resulting from participation.
Signature
Date

MonthDayYear
Date
Should be Empty: