Clone of May 16th 2025 Tri-Section Youth Rally

On Friday, Jan. 30th, 2026, IGNITE Youth of Life Place Church will be attending our PCG Merced Section Rally. The Rally will be held at Gospel Lighthouse Church Planada, 9684 Stanford Avenue, Planada

The service starts at 630pm, and food will be provided after service.

Parents and families are more than welcome to attend the service!

If students need a ride, please fill out this permission slip and Life Place Church staff and leaders will transport them. Departure time is 515pm from Life Place Church, and we will be arriving back to Life Place around 930pm. Students will contact their rides upon departure from the rally so they can get picked up from Life Place in a timely manner.

We are looking forward to this event, and I am praying that each of our students has an amazing encounter with God there.

For any questions, please contact Pastor Melissa Yonan (408)242-0316

Students Full Name

First NameLast Name

I, the parent/guardian of the student named above, agree with the following statements:

I hereby give permission for my child to take part in the trip described above.I understand that I am responsible for getting my child to and from the departure and return sites identified above. I understand that my child shall be accompanied by staff member(s) during the trip, including while traveling from the departure site to the destination site, and from the destination site to the return site.I understand that my student is expected to behave responsibly and to follow the school’s discipline code and policies.I agree and understand that I am responsible for the actions of my child, and I release Life Place Church from all claims and liabilities that arise in connection with the trip, except if due to the negligence church staff and leaders.I confirm that my child is medically fit and able to participate in all activities described above.I understand that as a parent, if I believe it is necessary to limit my child’s activity to a great extent, then the church may not be able to accommodate my child on this trip and that I and my child will be informed of this decision as soon as possible upon the receipt by the church of this completed consent form.I agree that in the event of an emergency injury or illness, the staff member(s) in charge of the trip may act on my behalf and at my expense in obtaining medical treatment for my child.I understand that alcoholic beverages and/or illegal drugs are prohibited and have discussed this prohibition with my child.

I have indicated below any permanent or temporary medical or other condition(s) including special dietary and medication needs, or the need for visual or auditory aids, which should be known about my child: (please write "N/A" if this does not apply to your child)

Emergency Contact Name:

First NameLast Name

Phone Number

Secondary Emergency Contact

First NameLast Name

Phone Number

Meals will be provided to all students. Please be sure to list any dietary restrictions/food allergies known to your child that the staff need to be aware of.

My child does not have any dietary restrictions.My child has dietary restrictions.

Are you interested in joining us as a chaperone? (may be required to drive)

YesNo

Name of Parent/Guardian

First NameLast Name

Date

Any additional notes you would like to submit concerning this trip.

Signature of Parent/Guardian

Merced Section Youth Rally