Friday Night Live Parental Consent

Below is the parental permission form for youth to be able to participate in Friday Night Live activities. If you prefer you may print a hard copy of this form here and submit directly to Pastor Amanda. Friday Night Live Parental Consent Form

Student's Name (Required Field) *

Street Address (Required Field) *

City/State/Zip (Required Field) *

Cell Phone Number: (Required Field) *

Student's Date of Birth (Required Field) *

Please indicate what grade your child is in: (Required Field) *

Parent/Guardian Name (Required Field) *

Parent/Guardian's Cell Phone Number (Required Field) *

Parent/Guardian's Email Address (Required Field) *

Additional Parent/Guardian's Name (If Applicable)

Parent/Guardian's Cell Phone Number (If Applicable)

Parent/Guardian's Email Address (If Applicable)

Emergency Contact's Name (Required Field) *

Emergency Contact's Relationship (Required Field) *

Emergency Contact's Phone Number (Required Field) *

Health Insurance Carrier (required field) *

Health Insurance Number (required field) *

Known Allergies/Special Needs:

Medications:

Self Carry Medications and direction for use (only those that would need to be taken during Friday Night Live, such as an inhaler, or an EpiPen)

Parent/Guardian's Name Who is Giving Medical Consent (Typing in your name will serve as your signature) (Required Field)

Parent/Guardian's Email (Required Field) *

Date Signed (Required Field) *

Emmanuel Lutheran Church Website Photo Release (Required Field) *

Grants permission to Emmanuel Lutheran Church to use images of the youth named on this form on the Emmanuel Website

Emmanuel Lutheran Church Facebook Photo Release: (Required Field) *

Grants permission to Emmanuel Lutheran Church to use images of the youth named on this form on the Emmanuel Facebook Page

Parent/Guardian's Name Who is Giving Photo Permission (Typing in your name will serve as your signature) (Required Field)

Parent/Guardian's Email (Required Field) *

Date Signed (Required Field) *

Parent/Guardian's Name Who is Giving Permission for Youth to Participate in Friday Night Live (Typing in your name will serve as your signature) (Required Field)

Parent/Guardian's Email (Required Field) *

Date Signed (Required Field) *

Website