SRYC All-Nighter Consent Form 2025
Please fill out this form and click submit.
Student Information
Student First and Last Name
*
Student Email
Student Phone
Student Address
*
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Does your child have any medical conditions or allergies that we should be aware of? If so, please provide details.
Any additional details you would like us to know about your child?
Parent/Guardian & Emergency Contact Information
Parent/Guardian First and Last Name
*
Parent/Guardian Email
*
This address will receive a confirmation email
Parent/Guardian Phone
*
Emergency Contact Name
*
Emergency Contact Relationship to Child
*
Emergency Contact Phone Number
*
Consent & Agreement
Digital Signature: By typing my full legal name in the box to indicate my digital signature, I hereby give permission for my child to participate in the All-Nighter, running from 8pm April 25th to 7am April 26th, at the Solid Rock Youth Center (150 Harrison Ave). I am therefore entrusting my child into the care of the capable staff and volunteers who are running the All-Nighter. By digitally signing my name, I also confirm all of the information I provided is accurate and that, in the unlikely event of an emergency, the staff and volunteers at the Solid Rock Youth Center may contact me to inform me of any emergency that may have occurred.
*
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Description
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