Group Out-trips Guardian Consent Form Delta Youth Counselling Boys and Girls Clubs of South Coast BC

 

    Guardian's Signature: Date:
    Guardian's Address:
    Guardian's Phone #:
    Youth's Date of Birth: Care Card #:

    Please List Allergies (Indicate if it is a serious allergy)

    Please List Prescribed Medications

    Do you consent to BGC to use photographs, video, etc. for publicity purposes connected with the promotion of the work of BGC?

    Emergency Contact
    Name: Phone #:
    Relationship: