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EC YTH Annual Student Permission/Medical Form '24
Please complete a form for EACH of your students participating in activities in Evangel Church. These will be kept on file for emergency contact/medical information.
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* Indicates required question
Child's FIRST Name:
*
Your answer
Child's LAST Name:
*
Your answer
Child's Date of Birth:
*
MM
/
DD
/
YYYY
Parent's Name:
*
Your answer
Parent's Phone Number:
*
Your answer
Please list TWO other emergency contacts name, phone number, and relationship to CHILD:
*
Your answer
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