Youth Mission Day Registration

Youth Mission Day Student Form

School You Attend*
Grade Level*
First Name*
Last Name*
Home Phone*
Student Email
Parent Email*
Address*
Street Address City State ZIP Code
T-Shirt Size*
- Small
- Medium
- Large
- X-Large
- XX-Large
Church Affiliation*
- Sign me up for any crew
If possible, put me on a crew with:
Code Of Conduct
Please read the Code of Conduct and digitally sign. As a participant in Youth Mission Day, I will be respectful of the residents and other members of my crew as well as all other participants. I understand that my cooperation and effort is part of our larger commitment to care for our neighbors in the community. I will participate 100% in all the Mission Day activities. I understand that disrespect towards people and property will not be tolerated at any time during this event. In the event this happens, my parents/guardian will be responsible for picking me up. I will not make phone calls and/or text during the Youth Mission Day unless absolutely necessary.
Student Signature*
Today's Date*
MM slash DD slash YYYY
Permission Form-All Information Below Is Required

I, the undersigned parent/guardian of
Student's Name*
grant my permission to the above to participate on April 30, 2022. This youth will spend Saturday at worksites in the Sussex area. This event is sponsored by the Cooperating Churches of Sussex. I am aware that the Cooperating Churches of Sussex does not assume any responsibility for any injuries incurred while being part of this service project. I release the Cooperating Churches of Sussex and its representatives from any claims arising out of my student's participation. I give my permission for any emergency medical treatment deemed necessary. Note: Due to church liability policy, no students or individuals under 21 are permitted to drive for Youth Mission Day.
Medical Insurance Carrier*
List any food/other allergies or medical conditions we should be aware of:
Parent Name*
Parent cell phone to contact during event:*