Youth Mentor Waiver and Consent Form Entry

Youth Mentoring Waiver and Consent Form

This form is to be completed once the Youth Pastor has paired your child with a mentor. You will be informed of the location and time of any and all mentoring meetings prior to them taking place. We will be recording that information along with a permanent attendance record.

Information received is confidential and is being gathered for the purposes of serving your child while in the care of Beulah Alliance Church. Any medical information collected here serves to authorize Beulah Alliance Church, and its staff and volunteers, to obtain medical assistance in emergencies. In the case of custody agreements, please include the proper form authorizing parental contacts.

First Name

Last Name

Student Email

Student Mobile Phone Number

I have completed a 2022-2023 Youth Registration Form

Medical Conditions/Dietary Restrictions/Allergies

Emergency Contact Name

Emergency Contact Phone Number

Youth Mentor Waiver and Consent

Youth Mentor Waiver and Consent Form Entry

Youth Mentoring Waiver and Consent Form

West Campus

Southwest Campus

BONNIE DOON CAMPUS

Faro De Luz