EmailMe Form - New Beginnings - Parent/Guardian Consent Form

Youth applying to attend New Beginnings: *
First Last
Parent/Guardian Name: *
First Last
Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Parent/Guardian Email *
Parent/Guardian Phone
### - ### - ####
Medical and Insurance Information
This information must be submitted to attend the event. Without this information, you will not be permitted to be a part of the weekend.

If not completed as part of your online registration, you must fill out the paper copy (available at www.etnyouth.org) and mail it to:

Youth Event Registration
814 Episcopal School Way
Knoxville, TN 37932
Name of Insured:
Insurance Carrier:
Policy Number:
Known medical concerns or drug/food allergies:
Please list any prescription or OTC medications taken regularly:
Any other medical/behavioral information that may be helpful to event leadership:
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