JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
students@faith 2019-20 form
Please fill out the following information for each of your youth.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Name
*
Your answer
Birth Date
MM
/
DD
/
YYYY
Current Grade
Choose
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
Current School
Your answer
Student email
*
Your answer
Parent email
*
Your answer
Address
*
Your answer
Student phone number
Your answer
Parent/Guardian name(s)
Your answer
Parent/Guardian phone number(s)
Your answer
Health Insurance company
CHP
Blue Cross/Blue Shield
Other:
Allergies and/or medications
Your answer
Dietary or other needs
Your answer
Physician name & phone number
Your answer
Dentist name & phone number
Your answer
In case of emergency, when parent/guardian is unavailable, who should we contact? Provide name and number.
Your answer
Before participating in any 2019-20 students@faith activities, you must fill out a permission form. Have you signed a form?
Yes
Not yet. I will use the link to print a copy and bring it to the church,
https://e905eac6e14c25ad85d3-b600258f72252680e3460388c3149f8f.ssl.cf2.rackcdn.com/uploaded/p/0e9084691_1565796958_parental-consent-for-medical-treatment-youth-events-2019-202.pdf
Clear selection
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Faith Presbyterian Church.
Report Abuse
Forms
