Momentum Conference
Jr. High

Student Name *

First Name

Last Name

Student Phone

(###)

###

####

Parent/Guardian Name *

First Name

Last Name

Parent/Guardian Phone *

(###)

###

####

Permission *

I, the undersigned, being the parent or legal guardian of the youth named above, do hereby consent to the participation of my youth in all the scheduled youth activities of Calvary Pentecostal Church. Further, I certify that my youth is physically fit and adequately prepared to participate in all recreational events. If I wish to revoke this consent for any reason, I will promptly notify the youth leader via email to luke@calvarydunnville.ca.

I have read and agree.