FLip-a-tin • youth form

We are joining the Cultural Collective to collect canned goods for our local Food Bank. Dress up or not, it’s up to you! Just come on out and join the fun! Register by Sunday, October 27.

Date: Thursday, October 31st Location: Meeting at the Cultural Collective on Main Street, Exeter Time: 5:30-8pm
Bring: Bags for collecting canned goods Leaders: Josh + Jess Owens, Alana Hodgert

Parent/Guardian

First Name

Last Name

Email Address

Primary Phone Number

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Child(ren)'s Information

First Child's Name

First Name

Last Name

Please list any medical conditions that we should be aware of (medications, allergies etc.)

Second Child's Name

First Name

Last Name

Please list any medical conditions that we should be aware of (medications, allergies etc.)

Third Child's Name

First Name

Last Name

Please list any medical conditions that we should be aware of (medications, allergies etc.)

Fourth Child's Name

First Name

Last Name

Please list any medical conditions we should be aware of (medication, allergies etc.)

Release of Care

Keeping your child safe is our number one priority at CFT. According to our Plan to Protect Policy your signature releases the care of your child(ren) to Centralia Faith Tabernacle from the time they are dropped off at the designated location until you pick them up or they are dropped off at home. Once they are picked up or dropped off they are released back into your care. Please be aware that it is our policy for your child to never be alone with a volunteer behind any closed doors or in vehicles. If you give permission for your child(ren) to walk or bike, written consent from you is required before we can release them to leave the church property. If you have someone other than a parent picking your child(ren) up, please let us know in advance. We will not release your children to anyone but the parents/guardian without your permission. This consent recognizes that all reasonable precautions will be taken to prevent accidents or injuries. Permission is given to allow supervision to seek emergency medical treatment. I have read and understand Release of Care Policy above and I hereby acknowledge on behalf of my son/daughter to absolve the church for any liability whatsoever. It also recgonizes that I am allowing CFT to use the information provided to contact me regarding my child and their involvement with CFT Youth Impact.

Any personal information given will not be used or disclosed except for the purpose of the Youth program at Centralia Faith Tabernacle. Pictures and/or names of children may be used for the purpose of promotion, celebration and to give information both in-house and on our social media sites. To protect the privacy of our children, no names will be listed or tagged by CFT. Email will be used strictly for informational purposes informing about upcoming events, cancellations, or changes occurring in the youth program.

Consent

Consent is given for the above to participate in the event

Media Consent

Yes, consent is given for my child(ren) to have their picture and/or video taken to be used as outlined above.

No, consent is not given for my child(ren) to have their picture and/or video taken to be used as outlined above.

Type your name here to consent

By typing your name and submitting this form you are agreeing to all of the policies listed above.