Complete this form, if you have anyquestions please call the church office. Parents / Guardians: Address: City: State: Postal | Zip Code: Preferred Phone: Alternate Phone: Email: Alternate Email: Emergency Contact Name / Relationship: Emergency Contact Phone: * Safe Sanctuary | Youth Photo & Video Consent Electronically Signed by Parent: Student 1: Birthdate: Age: Grade: Interests | Hobbies: Special Needs | Allergies Medical Information | Other: Student 2: Birthdate: Age: Grade: Interests | Hobbies: Special Needs | Allergies Medical Information | Other: Student 3: Birthdate: Age: Grade: Interests | Hobbies: Special Needs | Allergies Medical Information | Other: Type the answer: 1 + 9 =