Parent / Guardian Information

Name

Student Names *

This will be used to connect your profile to your student profile(s) in our system.

Relationship to Student(s) *

Mobile Phone *

You must be able to receive text updates and important alerts at this number.

Home Phone

(Optional)

Email *

Address *

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common.city

common.area

manageMemberFields.fields.ZipCode

I am the primary emergency contact *

Yes

Participation and Parent Consent *

I give permission for the student named above to participate in Antwerp Youth Group's regular Wednesday meetings and ordinary on-site ministry activities during the 2026-2027 ministry year.

I understand that AYG is a cooperative ministry involving multiple churches, and that program elements may include meals, worship, games, teaching, small groups, prayer, service activities, and reasonable physical recreation.

I agree to provide accurate and current contact, medical, allergy, custody, and authorized-pickup information. I understand that event-specific permission may be required for off-site, overnight, or special activities.

I have received or will review the AYG Parent & Student Handbook and will support its expectations for respectful behavior, safety, check-in/check-out, communication, and partnership with participating churches.

Signature *common.clear

Date *

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Parent / Guardian Information