Child/Youth Waiver

Parent/Guardian 1


Parent/Guardian 2


Child Information

Primary Residence of Child(Required)

Emergency Contact Information

Emergency Contact 1(Required)
Emergency Contact 2

Medical Information

Lifeway Church will only use this information in an emergency situation if we are unable to reach a parent/guardian or emergency contact.
I/we understand and agree that this permission and agreement shall remain in effect until revoked in writing by me/us, and I/we understand and agree that it is my/our responsibility to update our child/youth's medical and insurance information as changes occur.