ELEVATE Dodd City Youth Permission Slip

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On Wednesdays from 3:30 - 6:30 pm, youth in Grades 1st-12th are invited to join ELEVATE DC Youth at First Baptist Church Dodd City.

We will provide snacks, help with homework, recreation, an evening meal, a message from our Pastor Mike Haney, and then we will divide into smaller groups for lessons to dig deeper into God’s word.

If you would like for your child/youth to attend, please complete the information form below. We will begin on October 2, 2019.

Email *

Child's FIRST Name: *

Child's LAST Name: *

Guardian's FIRST Name: *

Guardian's LAST Name: *

Physical Address: *

Phone number #1: *

Phone number #2: *

Child's Date of Birth: *

YYYY

Child's Grade Level: *

Child's Age: *

Will your child ride the church bus from school to First Baptist Church Dodd City when school dismisses? *

Yes

Sometimes (if sometimes, please add additional info in "Other" space below)

Other:

Required

Will your child need a bus ride home on the church bus after we dismiss at 6:30 pm? *

The church bus can provide rides to youth who live in the greater Dodd City and Lannius areas.

Yes

Sometimes (if sometimes, please add additional info in "Other" space below)

Other:

Required

If yes, address to drop off child:

Does your child have your permission to attend ELEVATE Youth events and trips with us? We will provide details prior to any event or trip. *

Yes

Other:

Required

Does your child have any allergies? If yes, please provide details. *

Is there anything else we need to know about your child?

Guardian's Full Name for Digital Signature: *

Today's Date: *

YYYY

Submit

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