Coventry Youth - Live 412 Contact Form
Please fill out this form and click submit.
Coventry Youth, Live 412, is open to youth in grades 7-12.
Family Information
Parent Names
*
Address
*
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Parent Phone
*
Parent Email
*
This address will receive a confirmation email
Siblings and ages
*
Youth Personal Information
Name
*
Phone
*
Email
*
Birthdate
*
School Attending & Grade
*
Other Important Information
Do you have an allergies? If yes, please list them.
*
Do you have a home church?
*
Please select one option.
Yes
No
Looking for one
Select Option
Yes
No
Looking for one
People who may drive youth home:
*
Emergency Contact
*
Permissions
I, the parent or legal guardian of the above named, allow him/her to attend Coventry Church's Youth Group. I recognize the risk involved in activities and will not hold Coventry Church, its staff or volunteers, responsible for any personal injury that might occur to my child while participating in this program (games, activities, and trips are optional). I authorize a staff member or volunteer from the church to seek and obtain such emergency or medical services for my child as deemed necessary at the time.
*
Please select one option.
I agree
I do not agree (*disagreeing to this statement will restrict your child/children from full participation in Coventry Church's Youth Group.)
I give my permission for my child/children to appear on Coventry Church's website, Facebook page and/or other promotions.
*
Please select one option.
I agree
I do not agree
Submit
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