Name of Participant *

First Name

Last Name

Participant's Cell Phone (if applicable)

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Name of Additional Participant

First Name

Last Name

Participant's Cell Phone (if applicable)

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Name of Additional Participant

First Name

Last Name

Participant's Cell Phone (if applicable)

(###)

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Name of Additional Participant

First Name

Last Name

Participant's Cell Phone (if applicable)

(###)

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Parent/Guardian's Name *

First Name

Last Name

Parent/Guardian Cell Phone *

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Parent/Guardian Phone (other)

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Emergency Contact Cell Phone *

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Emergency Contact Phone (other)

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Consent to Receive Text Communications *

Texting may be used to coordinate activities and communicate event details to youth in grades 6-12. Any texts sent to youth will have the parent or an additional Trained Adult Leader included in the correspondence.

FPCLG staff and advisors may communicate with my teen via text as described above.

Photo Release *

I hereby give permission for the above named participant(s) to be photographed during children's and youth ministry events. I understand that these untagged photos may appear in newsletters, on the FPCLG website and/or on FPCLG Facebook and Instagram and that children and youth will NOT be named in any photo posted on the FPCLG website or on social media.

PARENT/GUARDIAN PERMISSION (participants 18 and over may consent on their own behalf) *

By selecting the "I Accept" button, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. By selecting "I Accept" you consent to be legally bound by this Agreement's terms and conditions. The above-named participant(s) has/have my permission to engage in the events described above. In consideration of the benefits derived from participation, I hereby voluntarily waive any claim against First Presbyterian Church, La Grange, Illinois 60525, or its staff or advisors for any and all causes that may arise in connection with this activity. In case of serious accident or illness emergency, we hereby give permission to the adult advisors to secure proper treatment for our children as named above.

I ACCEPT

Date *

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