Youth Spiritual Fasting Parental Consent Form

Youth Name Age Event/Activity Name Date(s) of Fasting Activity

Parent/Guardian Information

Parent/Guardian Name Relationship to Youth Contact Number

Medical Information

Does the youth have any medical conditions or dietary restrictions we should be aware of? Emergency Contact Name Emergency Contact Number

Consent & Acknowledgement

I, as the parent or legal guardian of the above-named youth, hereby give permission for my child to participate in the above-described spiritual fasting activity. I acknowledge that I have provided all relevant medical information and understand what this activity involves.

Parent/Guardian Signature Date