Youth Release Form (2019)

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This form is used for parent/guardian consent for trips taken by the Episcopal Youth Community (EYC) and other youth at Church of the Holy Family. All information will be used only by the staff of Holy Family for the purpose of the events.

We appreciate your taking the time to fill it out.

Parent/Guardian #1 *

Phone Number for Parent/Guardian #1 *

Email for Parent/Guardian

Parent/Guardian #2

Phone Number for Parent/Guardian #2

I give permission for trip leaders to contact my student(s) by phone through GroupMe text or individual phone calls during the duration of trips. * *

Yes

Student Name(s) *

Phone Number of Student(s) *

Prescription or OTC medications to be sent with student(s). (Please include dosage information and send all prescriptions in original bottles.) *

Student Allergies *

Emergency Medical Care: Should my child require immediate or emergency medical care while engaged in an activity by the Church in my absence, I hereby grant the Church authority to release my child for medical treatment by such medical personnel as the Church determines appropriate under the circumstances. *

Yes

Photo Release: Holy Family may use photos from this trip on the following private social media accounts in order to share updates with the parish: Holy Family Facebook Bulletin Board, Christian Education Facebook Page, Holy Family listserv (Mailchimp) and Christian Education Instagram. *

Yes

Other:

Parent/Guardian Electronic Signature (Please use your full name): *

Submit

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