Hawley Alliance Youth Release form
Name of Organization: Hawley Alliance Church Address: 404 Peters street Hawley Mn. 56549 Telephone: (218) 483-3426 Name of Sponsors Coordinator: Pastor Troy Mapes
Name of Participant:
Name of Parents/Guardians:
Name of Emergency contact:
List allergies or medical conditions
Is the Youth Pastor/Leader authorized to approve medical treatment if needed?
Is the participant covered by personal/family medical insurance?
If yes, name of insurer:
Policy or group number:
is there anything that your student should NOT engage in?
I have read and fully agree to the Participation Agreement (which is found on the Hawley Alliance Website under Ministries tab click Students)
Electronic Signature of Parent/Gaurdian
Your Email Address
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