Corn Maze Permission Form

On Saturday, October 17th, Empower Youth will be heading to the Corn Maze in Thamesville for the evening. We will plan to leave from GDAC for the CornMaze at 5:00pm. Students are expected to return back to GDAC around 9 - 9:30pm. If your youth would like to attend the evening with us, please fill out the section below.

The Cost per person is $20 and includes admission to the park, a pizza supper, and a smores' snack.

All students will be transported by vehicle(s) to/from the corn maze by youth leaders (unless otherwise noted). Please fill out the appropriate selections below if you will be dropping off/picking up your child at the corn maze.

Students Name

First NameLast Name

Students Grade

If you will be attending the corn maze, you may etransfer the cost to office@gregorydrive.com Note: Empower Cornmaze, or deliver cash to Jessica Fieldus at the church.

I, parent/guardian name* give my child child's name* permission to attend the Corn Maze in Thamesville with Gregory Drive Alliance Church Empower Youth.

I consent to having my child transported by vehicle to and from the corn maze in Thamesville by the Empower Youth leadership team. initial here

I will be dropping my child off at the corn maze.

I will be picking my child up from the corn maze.

Parent/Guardian Name

First NameLast Name

Parent/Guardian Email

example@example.com

Emergency Contact Phone

Please enter a valid phone number.Format: (000) 000-0000.

Signature

Corn Maze Permission Form

Authorization and Consent