CHILD CONSENT FORM

Children Ministries Consent Form

Child*
Date*
MM slash DD slash YYYY
Parent's*
Phone*
City*
State*
Zip Code*
School*
Grade in or going into*
Emergency Contact*
Emergency Contact Phone*
Allergies*
Medications*
May we administer Tylenol if needed?*
Parental Consent
Consent*
Wayne Street Church has my consent.
I (WE) are the parent or guardian and have given our consent for our child to participate in activities within the Wayne Street Church.
Parent/Guardian (print)*
Parent/Guardian (Signature)*
Parent/Guardian (print)
Parent/Guardian (Signature)
Date*
MM slash DD slash YYYY

130 North Wayne Street | St. Marys, Ohio 45885

130 North Wayne Street
St. Marys, Ohio 45885

Phone: 419.394.3615
Fax: 419.394.6919

WELCOME