Findlay Evangelical Free Church

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Request the service of our Youth

Youth Prayer Request Form

Youth Prayer Card

Your Name(required)

Confidential

Prayer Request

Code to help you brainstorm: PR, OC, WOW, Thanks, 31 Flavors

PR = Prayer Request, OC = Open Chair: who do you know that really needs God, WOW = worry of the week, Thanks = something we can praise God with you about 31 Flavors = a virtue that you are trying to put into your life. An area you are trying to develop

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Youth Medical Release Form

Findlay E-Free Youth Ministry Medical Release Form High School
Students Name
Age
Birthday
Grade in School
Gender
Email Address(valid email required)
Address
City
State
ZIP
Home Phone Number
Cell/Pager Number
Medical Insurance Company
Medical Policy #
Mother's Name
Mothers Phone Number - Home
Mothers Phone Number - Work
Father's Name
Fathers Phone Number - Home
Fathers Phone Number - Work
Emergency Contact
Emergency Contact Phone Number - Home
Emergency Contact Phone Number - Work
Physician
Physician Office Phone
Dentist
Dentist Office Phone
If necessary, describe in detail the nature and severity of any physical and/or psychological ailment, illness, propensity, weakness, limitation, handicap, disability, or condition to which your child is subject and of which the staff should be aware, and what, if any action of protection is required on account thereof. Submit this notification in writing and attach it to this form. Include names of medications and dosages that must be taken.
For your child’s safety and our knowledge, is your student a
Does your child have allergies to
Does your child suffer from, or has ever experienced, or is being treated currently for any of the following:
Date of last tetanus shot
Please list and explain any major illnesses the child experienced during the last year:
Additional Comments
For your information, we expect each student to conform to these rules of conduct No possession or use of alcohol, drugs, or tobacco No students can drive No fighting, weapons, fireworks, lighters, or explosives No offensive or immodest clothing No boys in girls’ sleeping quarters and no girls in boys’ sleeping quarters unless otherwise specified Participation with the group is expected Respect property Respect one another, staff, and adult leaders Respect and comply with event schedules No inappropriate physical displays of affection Students who fail to comply with these expectations may be sent home at their parents’ expense.
I, the parent, have filled out this Medical Release form. After every effort has been made to contact me at the numbers I’ve provided, I give permission to the youth leaders of Findlay E-Free Church to seek whatever medical attention is deemed necessary for the well-being of my child, I release the Church and its staff of any liability against personal losses of named child.
Parent Approval
Date
I, the student, have read the medical history and the rules of conduct, and I agree to abide by the stated personal limitations and code of conduct.
Student Approval
Date