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Wayside Youth Activities Form
This form is a release for participation for activities sponsored by
Wayside Friends Church
. Thank you doing this extra step to keep your student(s) and our youth community safe.
QUESTIONS
Connect with Wayside's Youth Pastor, Rachelle Byerley [she/her]
rachelle@waysidefriends.org
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* Indicates required question
1st Student's First + Last Name
*
Your answer
1st Student's Pronouns
Your answer
1st Student's Email
Your answer
1st Student's Cell Number
[if applicable]
Your answer
2nd
Student First + Last Name
[if more than one student within family]
Your answer
2nd
Student's Pronouns
Your answer
2nd
Student's Email
Your answer
2nd Student's Cell Number
[if applicable]
Your answer
Parent/Guardian's Full Name(s)
*
Your answer
Parent/Guardian's Phone Number
*
Your answer
Parent/Guardian's Email:
*
Your answer
Additional Emergency Contact Name + Relation to student + Phone Number
*
Your answer
Can we use pictures of your child in promotional materials?
*
This could include, but not limited to, social media, church slideshows and church website, and other mediums.
Yes.
No, I would prefer to not have pictures of my child used in this way.
I, as the parent/guardian, allow my student(s) listed above to participate in provided youth events and activities with the Wayside Friends Church including transportation to and from events.
*
Yes.
No.
Any extra notes that would be helpful for student/s to have successful experiences:
*
Your answer
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