Diocese of Allentown Youth Ministry Liability Release and Medical Information
Medical forms need to be completed every year and are good from September to August. It is the parent's responsibility to fill out a new medical form if any information changes! Each form is to be filled out separately for each teen in the household.
Email *
Student name *
Birthday *
MM
/
DD
/
YYYY
Gender *
Home Address *
Student cell *
Student email *
Grade *
School attending *
Adult t-shirt size *
Parent name(s) *
Parent email(s) *
Best number to contact in case of emergency (list all and specify if home, cell or work phone) *
Are you ok with texts to your cell about youth group or from Heather directly? *
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