Youth Information Form

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Please complete this form in it's entirety. This is for internal purposes only. If your child is going to participate in Children's Church or any youth related activities this form will help us facilitate communication with you (parents/legal guardian) in the event that your child needs help in the restroom/diaper change or for behavior issues.

**Please note that Harmony FWB Youth workers CAN NOT administer medications of any kind**

Email *

Child's Name *

School Child attends *

Child's Age and Grade (if applicable) *

Please list any food allergies or medical needs your child may have. *

Parents/Legal Guardian's names and contact information. *

Phone number to text should we need to contact you. *

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