Please complete the following information for your youth:

Youth 1

Youth 1's Health History

Youth 2

Youth 2's Health History

Youth 3

Youth 3's Health History

Parent/Guardian Information:

Emergency Contact

Family Home Church

Parental/Guardian Consents

Photo Consent: I do hereby grant permission to Indian Valley Faith Fellowship for the use of photograph(s) or electronic media images of my minor child/ren of any kind, in any presentation, including but not limited to live streaming and recording of services and events, social media pages and marketing materials. I understand that I may revoke this authorization at any time by notifying the IVFF office in writing. The revocation will not affect any actions taken before the receipt of this written notification.

By checking the box below I hereby release Indian Valley Faith Fellowship Church, its personnel, volunteers and employees,  from any and all liability, responsibility, claims or actions of every kind, including but not limited to property damage, public liability, or personal injury as a result of any Illumin8 activity in which my child is involved.  Furthermore, I/we hereby grant our/my permission for said participant to participate fully in all activities and hereby authorize medical treatment, including but not limited to emergency surgery or treatment, and I/we assume full responsibility of all medical costs, if any.