2021-2022 Guardian Consent Form

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2019 - 2020 Guardian Consent Form

Thank you for entrusting your youth student with us. Please fill out the following information. This information is to help Pastor Kagen and Mackenzie keep in touch with parents/guardians about upcoming youth events, changes and /or cancellations. We also need to have all information in case of emergencies. If we need to drive your student anywhere we must have this form. Please keep us updated in any information changes. If so, please contact Mackenzie Larsen.

Student Name *

Student's Date Of Birth *

YYYY

Gender *

Female

Male

Student Email

Address *

Student Phone number

Guardian #1 Name (First, Last) *

Relation to Student *

Guardian #1's Email *

Guardian #1 Cell Number *

Guardian #2 Name (First, Last)

Relation to Student

Guardian #2 Email

Guardian #2 Cell Number

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