PACIFIC NORTHWEST QUARTERLY MEETING

YOUTH SPONSORSHIP FORM

Send two copies of this form per child or youth under 18 years of age

attending Quarterly Meeting without a parent or guardian.

One copy is to be given to the Sponsor listed below, and one copy included with your child’s registration.

My child, , has my permission to attend the weekend retreat of Pacific Northwest Quarterly Meeting, April 26 - 28, 2019, at Lazy F Camp and Retreat Center near Ellensburg, WA.

(an adult attending this Quarterly Meeting session) has agreed to sponsor and supervise him/her.

I understand that the group may participate in outdoor activities. I agree to hold Pacific Northwest Quarterly Meeting, the Religious Society of Friends, and Lazy F Camp and Retreat Center harmless for any injuries which may be sustained as a result of my child's participation in the retreat.

My child may be given emergency medical treatment if necessary, with the consent of the sponsor named above or an adult leader of the activity group for this age child.

Emergency Contact

Phone Number

Alternate Contact

Phone Number

Special Medical Conditions

Medications

Parent/Guardian

Printed Name

Parent/Guardian

Signature

Dated