Perkiomenville Mennonite Church - Youth Event Consent Form

First Name

Last Name

Date of Birth

Address Line 1

Address Line 2

City

State

Postal / Zip Code

Phone Number

Parent/Guardian Name

First Name

Last Name

Parent/Guardian Phone

Phone Number

Consent

I hereby give permission to secure emergency medical treatment, including anesthesia for my student during Perk Church Youth activities, in the event that I cannot be reached.

Media Release

I hereby give permission for photos/videos taken during Perkiomenville Mennonite Church Youth Events to be posted on church website, app, and/or social media.

Date Input

Perk Church Youth Event Consent Form

Service Times

Contact Info

Follow Us