Youth Ministry Annual Form 2017

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Youth Ministry Annual Form 2017

Annual Youth Form 2017
YOUTH PARTICIPANT

Address*

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PARENT/GUARDIAN 1

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PARENT/GUARDIAN 2

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EMERGENCY CONTACT

*Someone who doesn't live with the youth

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HEALTH INFORMATION
Has/does your youth:*

MEDICATIONS

If Yes, please provide the information below.

Name of Drug, Dosage, and Frequency

DOCTOR INFORMATION

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MEDICAL INSURANCE

RISK ACKNOWLEDGEMENT AND RELEASE*

Sign in the space above by writing your name. By signing you acknowledge and represent that you have read and understand the Risk Acknowledgement and Release above. Also, you accept the Assumption of Risk, Medical Release, Transportation Release, and Media Release.