List First Name

List Last Name

Phone number for emergency contact. If visiting parents and children are also in attendance please add their names and contact, too.

List each Student(s) name, date of birth and school grade, if applicable. Please list all children in this paragraph, including extended family/visitors expected during the year.

Please list name of child and more information regarding any medical issues. If none, please indicate that. Please comment for each student.

Youth ministries wouldn't happen without volunteers. Please indicate your top two areas of interest as a volunteer:

Youth ministries occasionally includes photos in church communications. Youth names or other identifying information are never included.

Mailing address

I give my permission for my child to participate in overnight and off-site activities with St. Paul's Youth Ministry. I understand that some of these activities involve travel in privately owned vehicles driven by adult volunteers or parish employees. I do hereby hold harmless and release St. Paul’s Episcopal Church, Cary, and all adult volunteers and employees from any liability in the event of any accident, injury, or loss of personal property involving my child during this activity. In the event of a medical emergency, I understand that every reasonable effort will be made to contact me at the phone numbers listed below. In the event that I am unable to make arrangements for emergency medical treatment for my child, I authorize any adult volunteer or parish employee associated with the Sunday School or Youth Group activity to consent to all necessary medical care in my absence. I also understand that payment for such services is my responsibility as the parent/legal guardian.