Youth Medical Release Form
If you have any questions regarding this form or registering for a youth event,
please contact the church office to speak with Carrie Larsen, Director of Youth and Young Adult Ministries,
at info@gpchurch.org.
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Student's First Name *
Student's Last Name *
Current Grade *
School Name *
Student's Primary Phone Number *
Student's Email Address *
Parent's First Name  *
Parent's Last Name  *
Parent's Primary Phone Number *
Parent's Email Address *
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