Encounter Youth Ministry

Encounter Youth Ministry

Parental Permission For For Events
Title of Event
Date of Event*

MonthDayYear
Date
Name of Student

First NameLast Name
Age
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Health Issues
Briefly explain any health related issues we need to be aware of to ensure proper care for your child.
Emergency Contact
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Parent/ Guardian Information
Name of Parent/ Guardian

First NameMiddle NameLast Name
Age
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Consent and Authorization
I, hereby grant permission to the above mentioned youth to attend the event hosted by the Encounter Ministry of Truth Center Ministries International.
Name of Parent/Guardian

First NameLast Name
Contact Number
Format: (000) 000-0000.
Signature of Parent/Guardian

Clear
Date

MonthDayYear
Date
Should be Empty:

Consent and Authorization