JOLT YOUTH @ CEDAR GROVE

Experience Jesus. Build Relationships. Have a Blast!

www.joltyouth.ca

JOLT EVENT PARENT PERMISSION FORM

Name of Event: ______________________
Date: ____________________
Time: ____________________
STUDENT CONTACT INFORMATION
Student Phone #
First Name
Last Name
Current Grade
PARENT CONTACT INFORMATION
Parent Phone #
Mothers Name
Fathers Name
Current Grade
EMERGENCY CONTACT INFORMATION
In Case of
Emergency Contact
(relationship)
Emergency Contact
Phone
IMPORTANT INFORMATION WE SHOULD KNOW
Medical
Information

I the undersigned parent/guardian give permission for my

daughter/son to attend the event above. I understand the details
and information that has been given for this event.
__________________________
Name and Signature of the
Parent