Redeemed Life Fellowship - Impact Weekend

Impact Weekend Registration Form

If your child would like to participate in this event, please complete the following form. (If you are under the age of 18, please have your parent or guardian fill out the information below.) By completing this form you understand that this is a public event where photographs and video may be taken of your child and can be used on social media.

Yes, I understand

Please select one of the following

I am the Parent/Guardian of the Participant

I am the Youth Leader completing this form with Parental Consent

I am over the age of 18

Participants Name

Birthdate

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Last Grade Completed:

So we can properly prepare, select one of the following.

Plans to attend Day 1 @ Redeemed Life Fellowship

Plans to attend Day 2 @ Lake End Park

Plans to attend both days

Allergies, Medical or Special Needs (Leave Blank if none).

Name: Parent/Guardian

Phone Number: Parent/Guardian

Emergency Contact Name:

Emergency Contact Number

Authorized Pickup #1:

Authorized Pickup #2:

Please choose one of the following.

Walking Home

I will pick my child up or and Authorized person listed above will pick up my child

My child(ren) will be attending with their youth group and will be leaving with their Youth Group

My child(ren) will be going home with an Event Worker

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