Parental Consent and Release for Powerhouse Youth Ministries

Girls Group Sign-up Form and Parental Consent & Release for Activities
The Lethbridge Family Services Girls Group is open to any girl aged 10–18 who would benefit from peer connections and activities. The group encourages learning, communication skills, creative expression, and cross-cultural exchange through a variety of fun and educational activities and field trips on Friday afternoons. The form below includes registration for the group, as well as a waiver and release for all activities.
1. Child/Participant Information
Child/Participant Full Name:*

First NameLast Name
Child/Participant Birthday: *
Day*
Month*
Year*
2. Permission for Activities
- Where we go: parks, libraries, the university, Youth One, and the Boys & Girls Club.
- Safety: I know that activities have some risks. Staff will supervise, but they cannot stop every accident.
- Health: My child/dependant is healthy and can play.
I agree that my child/dependant can join the Girls Group activities and trips with Lethbridge Family Services.
3. Medical Help
If my child is hurt or sick and I cannot be reached, I give permission for staff to call an ambulance or take my child to a doctor/hospital.
Alberta Personal Health Number:
Please tell us about allergies and medical needs your child/dependant has:*
For example: asthma, diabetes, dietary restrictions, or illnesses.
4. Photo Permission
YES, you can take and publish photos of my child.NO, please do not take photos of my child.
5. Going Home (pick up)
I will pick up my child.My child can walk or bike home on their own.Other person will pick them up.
Name of person allowed to pick up your child/dependant:
6. Emergency Contacts (who to call first)
First Emergency Contact Full Name:*

First NameLast Name
Phone Number:*
Second Emergency Contact Full Name:

First NameLast Name
Phone Number:
7. Signature
Parent/Guardian Name:*

First NameLast Name
Parent/Guardian Email Address:*
example@example.com
Parent/Guardian Signature:*

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Girls Group Sign-up Form and Parental Consent & Release for Activities

1. Child/Participant Information

2. Permission for Activities

3. Medical Help

4. Photo Permission

5. Going Home (pick up)

6. Emergency Contacts (who to call first)

7. Signature