MS Youth Group Permission / Information Form

MS Youth Group Permission / Information Form

Please fill in the form below.
Student's Full Name*

PrefixFirst NameLast Name
Date of Birth
Grade in School
I prefer that my child wear a mask when participating in MZ activities that are inside.*

YesNo
Student's Cell Number

Area CodePhone Number
Cell Service Provider (to send text from email)
Can this cell number be used to send ministry announcements?

YESNO
Parent's Full Name

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
Home Phone

Area CodePhone Number
Cell Phone

Area CodePhone Number
Cell Service Provider (to send text from email)
Can this cell number be used to send ministry announcements?

YESNO
People authorized to pick-up student from youth activities
Transportation Permission, blanks (type your name), give permission for my child, blank (type your student's name) to be picked up from Southern Middle School on scheduled Friday afternoons and to be transported to Mt. Zion Church (122 Bayard Road, Lothian) for Youth Group. Unless otherwise notified, Mt. Zion is the only destination my child will be transported to. My signature below gives consent for this. Signature
Do you give Mt. Zion UMC permission to use any photo or likeness of yourself or your child for promotional materials and materials shared with the public, via press releases, social media, and websites to raise public awareness of this ministry?

YESNO
Photo Release Form (adult signature required)

Clear
Should be Empty: