Youth Event

Countryside Fellowship Youth Event!

Please complete the form for your child to attend our Youth Fall Dance on October 30th from 6:30 pm to 8:30 pm. Please have your child picked up from the church NO LATER THAN 9 pm. A light meal will be provided for the kids. Games and Prizes! Please call 940-627-3924 if you have any questions or concerns. Thank you.
Participant's Full Name

First NameLast Name
Parent/Guardian Full Name

First NameLast Name
Parent/Guardian Email Address
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Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Waiver and Permission Statement: By signing below, I acknowledge that I am the parent or legal guardian of the participant. I give permission for my child to participate in the specified activity and agree to the terms and conditions outlined by the organizers. I agree to photos being taken of my child at the event and used on the church social media sites. I release the organizers from any liability resulting from participation.
Signature of Parent/Guardian
Date

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2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

Countryside Fellowship Youth Event!