JOLT YOUTH @ CEDAR GROVE

Experience Jesus. Build Relationships. Have a Blast!

www.joltyouth.ca

JOLT EVENT PARENT PERMISSION FORM

Name of Event: ______________________
Date: ____________________
Signed By: _________________________
Signature and Name of Parent/Guardian

STUDENT CONTACT INFORMATION

Student Phone
#
First Name
Last Name
Student Email
Current Grade
ADDRESS
Street Address
City, BC
Postal Code
EMERGENCY CONTACT INFORMATION
In Case of
Emergency
Contact
(relationship)
Emergency
Contact Phone
IMPORTANT INFORMATION WE SHOULD KNOW
Medical
Information