Youth Group Contact Form

Contact and Consent Form for Youth Group

* Indicates required field

Child's Name *

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Age/Grade *

Emergency Contact *

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Emergency Phone Number *

Any allergies or other info we need to know *

By signing, I agree to allow my child's temperature to be checked by FIMBC volunteers. *

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(only if your child is riding our vans) By signing, I agree to allow my child to ride the van to and from FIMBC. *

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Submit