Wayside + NVFC Youth Activities Form
This form is a release for participation for activities sponsored by Wayside Friends Church and/or North Valley Friends Church. Thank you doing this extra step to keep your student(s) and our youth communities safe.

QUESTIONS
Connect with Wayside's Youth Pastor, Rachelle Staley [she/her] rachelle@waysidefriends.org
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1st Student's First + Last Name *
1st Student's Pronouns
1st Student's Email
1st Student's Cell Number
[if applicable]
2nd Student First + Last Name
[if more than one student within family]
2nd Student's Pronouns
2nd Student's Email
2nd Student's Cell Number
[if applicable]
Parent/Guardian's Full Name(s) *
Parent/Guardian's Contact Phone Number
Lorelai, mom (111) 111-1111
 *
Additional Emergency Contact Name + Relation to student + Phone Number
Sookie St. James, family friend (222) 222-2222
 *
Which Church Community are you connected with?
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Can we use pictures of your child in promotional materials? *
This could include, but not limited to, Facebook, Instagram, Church Slideshows and Church Websites, and other mediums.
I, as the parent/guardian, allow my student(s) listed above to participate in provided youth events and activities with the church/churches named above: *
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