The Forge

YOUTH ACTIVITY online permission form and WAIVER

* Indicates required field

Student Name *

First

Last

Student's Date of Birth *

I hereby authorize the appointed representatives of Sanctuary to transport, minister to, authorize emergency treatment and to otherwise act in this child’s behalf when I can not be reached and/or when delay would be dangerous, in order to protect from harm.
In addition, I hold harmless Sanctuary and its representatives for any event in which the above child may be injured in any way. I understand that this permission and waiver is valid for the calendar year in which it was signed, unless personally revoked by me.

Parent/Guardian Name *

First

Last

By filling out this form I acknowledge that this is my electronic signature.

Parent/Guardian Email *

Parent/Guardian Cell Phone *

Name and Phone of Student's Physician *

Comment (Please include any information that would be helpful for us in ministering to your child) *

Submit

THE FORGE

YOUTH ACTIVITY online permission form and WAIVER