2017-2018 Registration and Permission Slip Student Name First Last Grade Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Student Birth Date Home PhoneParent/Guardian Name First Last Parent/Guardian Email Parent/Guardian Cell PhoneParent/Guardian Name First Last Parent/Guardian Cell PhoneParent/Guardian Email Present church affiliation: Any other information you would like us to know about your child or family:Help us share the love of Jesus Christ with our youth by: (check all that apply) Serving on the Hospitality Team that hosts our meals each week Driving for mission or fun nights Helping with fundraising Participating in special events 2017-2018 “All Events” Permission Slip My child has my permission to participate in activities off the Allentown Presbyterian Church campus, either walking or by vehicle. This permission slip covers but is not limited to Sunday School “road trips”, monthly youth group mission visits, fun events and retreats. I also grant permission to the Allentown Presbyterian Church to take and publish photographs, video, voice recordings, or any other likeness of my child/youth for use in published material (includes print, web-based (digital), and other media types) that may be presented in the public domain (outside Church services or Church-sponsored programs) for the purpose of promoting Church-sponsored programs, ministries, activities, or events. If I cannot be reached to approve emergency care, I authorize Crossroads Youth Staff to approve such care in my absence.Parent/Guardian Signature First Last Date MM slash DD slash YYYY * If you there are any medical issues that we should know about, please contact Jenna Brown at 609-256-0199.
