Fuse Youth Activities Release
Please fill out an annual release for your child's participation in Restoration Church youth activities. This form includes contact information, medical information, and video/photography information. Please fill out one form for each child.
Email address *
Name of youth *
Your answer
Birth Date *
MM
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DD
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YYYY
Name of parent(s) or guardian(s) *
Your answer
Address *
Your answer
Home Telephone *
Your answer
Work Telephone
Your answer
Other person and/or number to call in emergency. *
Your answer
Consent & Certification
I, the undersigned, being the parent or legal guardian of the youth named above, do hereby consent to the participation of my youth in all the scheduled youth activities of Restoration Church, and any other supervised activities customarily associated with its youth group, including youth conferences and overnight or weekend youth trips. Further, I certify that my youth is physically fit and adequately prepared to participate in all recreational and sporting events. If I wish to revoke this consent for any reason, I will promptly notify the youth leadership in writing.
(Note to parent) If giving consent for one activity only, or if this consent is otherwise restricted, please specify:
Your answer
By selecting the "I Agree" button you are acknowledging the consent statement above and that all information provided is accurate. *
My initials below constitute my digital signature and agreement to the above statements. *
Your answer
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