Youth Program Permission & Information Form

Youth Program Permission & Information Form

Complete one form per youth participant for the 2026–2027 program year, including emergency and medical/allergy details and permissions.
Youth Information
Youth Full Name

First NameMiddle NameLast Name
Grade as of September 1, 2026
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Parent/Guardian Name(s)

First NameMiddle NameLast Name
Parent/Guardian Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Email
example@example.com
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Emergency Contact
Emergency Contact Name

First NameLast Name
Relationship to Youth
Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Alternate Phone
Please enter a valid phone number.Format: (000) 000-0000.
Medical, Food & Environmental Information
Food allergies
Environmental allergies
Other allergies or important information
Emergency instructions or other information youth leaders should know
Photo & Video Permission
May photographs or videos of your child be taken and used by The Church of the Advent for church-related purposes without using your child’s name or age?
May The Church of the Advent use photographs or videos of your child in church advertisements, promotional materials, websites, newsletters, printed materials, or official church social media accounts?
Parent/Guardian initials
Parent/Guardian Acknowledgment
Acknowledgment
Youth Name
Parent/Guardian Printed Name

First NameMiddle NameLast Name
Parent/Guardian Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
For Church Use
Form Received By
Date Received

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Additional Notes
Should be Empty:

Youth Program Permission & Information Form

Youth Information

Emergency Contact

Medical, Food & Environmental Information

Photo & Video Permission

Parent/Guardian Acknowledgment

For Church Use