Youth A'Blaze In-Take

Youth Information

Date

Full Name

Address

Date of Birth

Allergies (If any)

Parent Information

Parent/Guardian Name

Address

Phone

This address will receive a confirmation email

Alternative Emergency Contact Name

Alternative Emergency Contact Phone

Photo & Media Release

I give Calvary Assembly of God Church permission to take photographs and/or videos of my child during Youth A'Blaze activities for use in church communications, social media, and promotional materials.

Photo & Media Consent

Yes, I consent No, I decline

Description

Please fill out this form and click submit.

Youth A'Blaze In-Take

Description

Please Fix the Following