THRIVE Youth Group Registration & Emergency Information 2021 - 2022
PARENT PERMISSION FOR PARTICIPATION AND AUTHORIZATION FOR EMERGENCY MEDICAL TREATMENT
Even if you have filled this out in the past we ask that you take a moment and submitt the form again :)

Cool Community Church
863 Cave valley Road, cool, CA 95614
(530)885-4385

Please use the email address below that you'd like to receive a copy of your Registration Document and be used as your primary email address for updates, etc.

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Student & Family Information
Please fill out one online form for each student that will be attending THRIVE Youth Group
Student First Name *
Student Last Name *
Allergy Information *
Please include and and all allergies, including food products, medications, essential oils, cleaning products, etc.) along with treatment in case of exposure.  If your student carries an Epi pen, inhaler or medication, please list that here as well.
Additional Important Info
Please tell us any other important details we should know about your student:
Student's Birthdate *
MM
/
DD
/
YYYY
Address *
Street, City, State & Zip of primary residence of student
Primary Phone Number & Emergency Contact *
Additional Parent/Guardian Contact Information
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