The following form must be filled out by a Guardian (18+) of the student participating. Please fill out 1 form per student. 

We will meet at Whites Road Pentecostal Church Friday, September 27th, 2024 (9171 Wellington Road 5, Harriston ON N0G 1Z0)

Doors open at 6:30pm and the event will end at 9:30pm. Students are responsible to have a ride to and from the event.  Please ensure that your youth is picked up no later than the event end time of 9:30pm.

Does your student have any physical, mental, or behavioural concerns that we should be made aware of? Please list them below.

Will your student be bringing any medications with them. Please list them below. 

By "submitting" this form, I/We, the guardians of the student listed on this form, authorize Pastor Jana or one of the Hope Community Church leaders to sign a consent for medical treatment and to authorize any physician or hospital to provide medical assessment, treatment or procedures for the participant named above. I, the parent/guardian give permission for my child to participate in 519 Youth Rally September 27th, 2024 and I assume the risks that may accompany such participation. I agree that Hope Community Church, its directors, employees, and volunteers should not be held liable for any loss, damage or injury to my child or my child's property arising or resulting from participation in the trip to 519 Youth Rally September 27th, 2024. I give Hope Community Church officials the authorization to act on my behalf in the event of an emergency.  This consent and authorization if effective only when participating in or travelling to and from events of Hope Community Church.