412 Youth Parents Permission Form
Please fill out this form and click submit.
Let's Go To The Movies!
Date : March 21 (Wednesday)
Time : Dinner 6:00pm at Entiat Warehouse Community Church
Leave : 6:30pm Back : 9:30pm
Bring : $5
Student's Name
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Age
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Grade
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Parent or guardian name
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Email
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This address will receive a confirmation email
Phone
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Physical Address
*
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Mailing Address
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AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Please list any allergies, medical concerns, or special learning needs
Emergency contact if parent cannot be reached
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Phone
*
Please list any adults, not previously listed, that are authorized to pick up your children
*
WAIVER OF LIABILITY & MEDICAL RELEASE
I give permission for my son/daughter to attend the above event. In the event of injury, I release Entiat Warehouse Community Church from any claim. I give permission for my son/daughter to ride in any vehicle designated by the adult in charge. I give permission for the person in charge to seek medical services if needed. By checking, I agree to the conditions of the Waiver of Liability & Medical Release.
*
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