Impact Youth Fellowship Registration Form

Dear Parents/Legal Guardians,

"Youths impacting lives with God's truth and love"

According to our Church and District By-Laws, we are required to have your consent and
emergency health and contact information for each of your children. We require separate forms for each child even if you have several in our group. Please fill in the form and return it to us ASAP. For ALL events leaving Church Property, we will Inform and send home waivers for each individual outing.

If you have any questions and/or concerns please do not hesitate to contact Pastor Ray Chia at 778-791-6818 or rayc@westwoodac.org

Youth's First Name (called name) *

Youth's Last Name (Surname) *

School Grade *

Youth Cellphone Number (if applicable)

Medical/Special Needs *

Parent's/Legal Guardian's First & Last Name (Surname) *

Parent's/Legal Guardian's Contact Number *

Parent's Main Communicating Email Address *

By checking the box(s) I consent to having my child's picture taken and used within Westwood Alliance Church's context, including the Church's website, app, and/or Instagram. (Please check which ever is applicable)

Westwood Website

Westwood APP

Westwood/Impact Youth Instagram

None of the Above

Impact Youth on-site activities

By checking the box , I give my consent to allow my youth to participate in ALL formal activities and events of the Westwood Alliance Church Youth Groups held within the Church. I understand that precautions have been taken to minimize any possible injuries and sickness and the greatest care will be given to take care of my child.