2021-2022 Guardian Consent Form
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.  

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Student Name *
Student's Date Of Birth *
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/
KK
/
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Gender *
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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