Guardian Consent Form for BGC Annex Out-Trips


    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 #: