Complete this form, if you have anyquestions please call the church office. Parents / Guardians: Address: City: * Safe Sanctuary | Youth Photo & Video Consent Electronically Signed by Parent: Emergency Contact Phone: Emergency Contact Name / Relationship: Alternate Email: Email: Alternate Phone: Preferred Phone: Postal | Zip Code: State: 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: 4 + 8 =