Teen's Name (Required)

Parent/Guardian's Name (Required)

Parent/Guardian's Phone Number (Required)

Emergency Contact Name and Phone Number (Required)

Any Food or Drink Allergies (Required)

Any other information you would like us to know about your teen (Required)

I consent to allow my teen(s) to participate in this event and give permission to the Fostoria Church of God Pastoral staff and Leaders to take responsible care of my teen(s) during this time (Required)