Youth Force 2025 @ East Cross
Youth Force Bartlesville will be at East Cross Church in Bartlesville June 15-20th. 
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Participants First Name
Participants Last Name
Participant Incoming Grade
Clear selection
Birthday
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DD
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Gender
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Home Church *
T-Shirt Size *
Parent/ Guardian Name
Parent/ Guardian Phone Number  *
Parent/ Guardian Email Address *
Emergency Contact (alt of parent listed above) *
Emergency Contact relationship *
Emergency Contact Phone Number *
Insurance Name and Policy Number *
Allergies
Are there any medical conditions we should know about? 
Medications, dosage, and times
Last Date of Tetanus Shot *
Food restrictions
Participants experience with tools, and worksite knowledge?  *
I have been informed and understand that East Cross Church will be taking photographs of children attending sponsored activities, including this trip, and that these pictures may be viewed inside the church building, on the East Cross website or other outside publications. *

I give my permission for my child to receive pain relievers (such as Tylenol, Advil, etc.), antacids, and Benadryl from the supervising adults at this church function.

*

I understand that in the event medical intervention is needed, every attempt will be made to contact immediately the persons listed on this form. In the event I cannot be reached in an emergency during the activity dates shown on this form, I hereby give my permission to the physician or dentist selected by the activity director to hospitalize, to secure medical treatment and/ or an injection, anesthesia, or surgery for my child as deemed necessary.

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I understand all reasonable safety precautions will be taken at all times by East Cross Church and its agents during the events and activities. I understand the possibility of unforeseen hazards and know the inherent possibility of risk. I agree not to hold East Cross Church, its leaders, employees, and volunteers liable for damages, losses, diseases, or injuries incurred by my child listed on this form.

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I understand that all youth and church events are drug free, THC free, nicotine free (including vaping), alcohol free and weapon free. If my child is caught with any illegal substances at church or on a trip, I will work with event leadership to make amends. This can include coming to retrieve my child in the event they are sent home. *
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