2024 Parent/Guardian Release for FGC Gathering
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Program Participant
Participant's First Name
Participant's Last Name
Participant's Date of Birth
Which program is your child in?
High School Program (rising 10th grade and older)
Junior Gathering (birth - rising 9th grade)
Is this the participant's first time in the HS program?
Yes
No
High schoolers will be required to sign High School Program Guidelines and Expectations during check-in on the first day of the event.
You may read the guidelines online here.
Participant's Sponsor
Will you as parent/guardian be attending the FGC Gathering with your child?
Yes
No
Will the parent or sponsor be sleeping on campus or commuting?
Campus
Commuting
Sponsor Name (if parent/guardian is not attending Gathering)
For commuting parents/sponsors
Name of overnight sponsor
If an overnight sponsor is not named above,
I (or my child’s sponsor) will identify an overnight sponsor who is sleeping on campus no later than High School first-night orientation.
Yes
As a parent/guardian, I have asked this sponsor to act on my behalf at the FGC Gathering, which may include being alone with my child.
Please initial below:
In the event of temporary absence from the FGC Gathering, the sponsor named above is authorized to designate a Temporary Sponsor.
Please initial below:
Parent/Guardian Information for ALL Youth Participants
This section must be completed by parents/guardians for all participants.
If parent/guardian is NOT attending the FGC Gathering, please also name sponsor in box above.
Parent/Guardian's First Name
Parent/Guardian's Last Name
Monthly/Yearly Meeting
Other Quaker affiliation (organization, school, camp etc.)
Parent/Guardian's Street Address
City
State/Province
Zip/Postal Code
Country
Daytime phone (include area code)
Evening phone (include area code)
Cell phone (include area code)
Parent/Guardian's email address
Alternate Emergency Contact
Name
Relationship to child
Daytime phone (include area code)
Evening phone (include area code)
Cell phone (include area code)
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Health Insurance
Health Insurance
My child currently has health insurance.
My child will have health insurance by July 2024.
My child does not have health insurance.
Company Name
Policy Number
Does your child have allergies?
Yes
No
Please specify:
Release
I give permission for my child named on this form to participate in this year's FGC Gathering and to participate in all planned program activities both on and off campus. I understand that my child will be expected to abide by all rules and guidelines. I hereby release Friends General Conference (FGC), its staff and volunteers, from liability for any injury or illness that my child may experience during the Gathering. In the event of an emergency, I hereby authorize FGC Gathering staff and organizers, or the above-named sponsor, to consent to any medical, surgical, or psychiatric care advised by licensed health care providers. I hereby release Friends General Conference from any liability, legal or financial, for emergency care provided to my child. I expect to be informed as soon as possible. I also agree to allow the FGC High School counselors, Junior Gathering Clerks, and group coordinators to administer over-the-counter pain medication as indicated below when requested by my child at the 2023 FGC Gathering.
Acetaminophen (Tylenol)
Yes
No
Ibuprofen (Advil)
Yes
No
Other approved medication:
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About Your Child
Staff and parents/guardians share responsibility to optimize each participant's opportunity to succeed in the program. In order to create a supportive environment for all participants, it is essential that we know of any youth needs in advance.
Most questions below are optional. We welcome you to complete those that feel most relevant to your child's current experience. Thank you for helping us get to know your child and offer them our best support!
What are some of your child's biggest:
Joys right now:
Struggles to deal with right now:
Recent achievements:
Recent challenges:
Recent significant changes in their life:
Any physical and/or mental health concerns?
Yes
No
If yes, please explain:
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Which learning style works best for your child ? Choose all that apply.
Kinesthetic (movement)
Audio/Aural
Visual
Written
Verbal
Solitary
Social
Other
Does your child use memory aids?
Yes
No
If so, what works best for them?
What makes it most likely that your child will deal with expectations successfully?
Contact Information