MBC Youth Group Consent Form
Youth's Full Name *
Your answer
Gender
Youth's Date of Birth
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Grade as of 9/1/2019
Youth's School
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Youth's Email
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Youth's Cell Phone
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Mother/Guardian Name
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Mother/Guardian Cell Phone Number
Your answer
Mother/Guardian Email
Your answer
Father/Guardian Name
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Father/Guardian Cell Phone Number
Your answer
Father/Guardian Email *
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Home Address *
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Home Phone
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Person Responsible for Medical Bills & Care
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Emergency Contact Person
Your answer
Emergency Contact Phone/Cell Number
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Medical Information (allergies, asthma, medication, etc.)
Your answer
Comments
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