MBC Youth Group Consent Form

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This form is for teens and parents/guardians to complete in order to provide contact and emergency information. This form also acts as a permission slip for weekly meetings and all events from September 1, 2024 through August 31, 2025. Information for trips, events, and activities will be provided at Friday night meetings and in the bi-yearly calendars.

Teen's Full Name (One teen per entry) *

Gender *

Female

Male

Teen's Date of Birth *

Grade as of 9/1/2024 *

Teen's School

Teen's Email (optional)

Teen's Cell Phone (Optional)

Mother/Guardian Name *

Mother/Guardian Cell Phone Number *

Mother/Guardian Email *

Father/Guardian Name *

Father/Guardian Cell Phone Number *

Father/Guardian Email *

Home Address (optional)

Home Phone (if different from cell phone)

Person Responsible for Medical Bills & Care *

Emergency Contact Person *

Emergency Contact Phone/Cell Number *

Medical Information (allergies, asthma, medication, etc.) *

Parent/Guardian of the teen named above, type your full name in the space below to give permission to your child to attend weekly youth group sessions and join the MBC youth group members and leaders on trips from September 1, 2024 through August 31, 2025. *

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