|
For any overnight events or other events that need parental permission the form below should be completed. |
|
Westway Youth Group
Westway Church of Christ Event Application Event: ________________________________
Date: _________________________________ Event Details: __________________________ Cost: £________ Application Due Date:____________________ Please make Cheques payable to: Westway Church of Christ (Please submit form & registration money to: Gentry Morris) Student Information Last Name:_____________________________ First Name:_____________________________ School Year:____________________________ Age:__________ Gender: M | F (circle one) Phone:_________________________________ Email:_________________________________ Address:_______________________________ City:__________________________________ Postal Code:____________________________ Parent / Guardian Information Name(s):_______________________________ Email:_________________________________ Home Phone:___________________________ Other Phone:____________________________ Medical Information Health Card #:___________________________ Health Card Expiry Date:___________________ Medical Conditions or Allergies:_____________ _______________________________________ _______________________________________ _______________________________________ (Please make special note of food allergies) Medication(s) Currently Being Taken:________ ______________________________________ (Please note medication names and times taken) Permission Form Student: I promise to abide by all rules and plans set forth by the leaders of Westway Youth during the course of this event. I understand that these rules and plans have been made for the safety of myself and the group. I understand that if I do not abide by the rules and plans set forth that I may not be allowed to participate in the event. Signature:_______________________________ Date:__________________ Parent/Guardian I / we are the legal guardians of the student named above and hereby give my / our permission for the named student to participate in the above named event with the leaders of Westway Youth Group. I understand that in the event of an emergency that the leaders of Westway Youth Group will do everything in their power to contact me personally, but that in the event that they are unable to do so, I / we give my / our permission for the leaders to seek necessary medical attention for the student named above. I / we understand that the student named above has read and agreed to the terms set about by the leaders of the Westway Youth. I / we understand that photographs and video of the event will be taken. Signature:________________________________ ________________________________ Date:___________________ Office Use Only Approved (Circle One): Yes / No Paid:__________ Owed:_________ |
