Name of Youth Participant *

First Name

Last Name

Youth Participant's Cell Phone Number (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. 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 child via text as described above.

Photo Release *

I hereby give permission for my child to be photographed during FPCLG events. I understand that these untagged photos may appear in newsletters and on the FPCLG website, Facebook page and/or Instagram account and that my child will not be named in any photo posted on the FPCLG website or on social media. I will contact Diane Stapleton at 708.354.0771, ext. 43, or dstapleton@fpclg.org if I have a concern about my child being photographed.

COVID-19 Safety *

My child agrees to adhere to mandatory mask-wearing and social-distancing policies.

PARENT/GUARDIAN PERMISSION *

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 has 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 child as named above.

I ACCEPT

Date *

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