Fuse Youth Activities Release

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Please fill out an annual release for your child's participation in Restoration Church youth activities. This form includes contact information, medical information, and video/photography information. Please fill out one form for each child.

Email *

Name of youth *

Birth Date *

YYYY

Name of parent(s) or guardian(s) *

Address *

Home Telephone *

Work Telephone

Other person and/or number to call in emergency. *

Consent & Certification

I, the undersigned, being the parent or legal guardian of the youth named above, do hereby consent to the participation of my youth in all the scheduled youth activities of Restoration Church, and any other supervised activities customarily associated with its youth group, including youth conferences and overnight or weekend youth trips. Further, I certify that my youth is physically fit and adequately prepared to participate in all recreational and sporting events. If I wish to revoke this consent for any reason, I will promptly notify the youth leadership in writing.

(Note to parent) If giving consent for one activity only, or if this consent is otherwise restricted, please specify:

By selecting the "I Agree" button you are acknowledging the consent statement above and that all information provided is accurate. *

I Agree

My initials below constitute my digital signature and agreement to the above statements. *

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