Name (Required)

Email Address (Required)

Student's Name (Required)

School grade for 2025-26 (Required)

Parent Phone Number (Required)

Emergency Contact (and relationship to child) (Required)

I understand that by checking this box, I give my permission and consent for my child to participate in the various activities, events, and trips, that are a part of the Southshore Youth Group.These events include, but are not limited to: youth studies, ev (Required)

I consent to my child being driven by approved youth leaders to an event if required, and with my prior knowledge. I understand they will never be on their own with a youth leader in a car. (Required)

I consent to the use of photos of my child for the promotional purposes of Southshore Bible Church on their website, social media, announcement slides or church app. I understand that my consent can be withdrawn at anytime (Required)

Electronic Signature (Required)

Date of electronic signature (Required)