Youth Volunteer Name *

First Name

Last Name

Phone Number *

(###)

###

####

Youth Volunteer Birthdate *

MM

DD

YYYY

Permissions (Completed by Parent/ Guardian) *

I give my permission to have my child photographed or filmed for in-church historical and publicity purposes.

I give my permission to have my child’s photo published online (no identifying information attached!) on our church website or Facebook page.

I agree that all of the information submitted here is correct.