IMPACT YOUTH PERMISSION FORM
Date of the event
-
Month
-
Day
Year
Date
Name of the Event
Name
First Name
Last Name
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Emergency Contact Name
First Name
Last Name
Emergency Contact Phone Number
-
Area Code
Phone Number
Do you hereby authorize Impact Youth Ministry the permission to transport and/or monitor your child to/at this event?
Yes
No
Child's Name
First Name
Last Name
Please sign below:
Submit
Print Form
Should be Empty: