PGC Grounded Youth Group 2026

Please submit a new form for each student (GRADES 6TH AND ABOVE ONLY)

Child Information

Name

Birthdate

Current Grade

Allergies and Medical Conditions (Snacks and food will occasionally be served or crafted with. Active games and challenges may be planned as well. Please use this space to be specific about any concerns)

Parent Information

Parent Name

This address will receive a confirmation email

Address

Phone

In the case of an emergency, the above contact will be notified first. Please use the space below for additional emergency contacts in the order of importance (name, phone number, relationship to child)

Please sign each statement below

Youth Group Liability Release: I give permission for my child to participate in Youth Group at Proving Ground Church of Lakehurst, NJ. As parent/legal guardian of said minor, I accept full responsibility for any medical costs incurred in the event of an accident or other emergency.* After reasonable efforts have been made to contact me or my spouse I grant the volunteers of PGC permission to make any and all necessary medical decisions for my child until I arrive.

I grant permission for Proving Ground Church to take photos/video of my child(ren) during church events and to use these images in church publications, website and social media. I understand that photos and videos will NEVER be accompanied by captions or tags that include names or any other identifying information.

By signing you are permitting your child to participate in physical activities and edible snacktivities. If your child has allergies or medical concerns of any sort, please use this section to be very specific.

Dropoff and Pickup Procedures

In 2026, PGC Grounded Youth Nights will be held on Wednesday evenings from 6:30-7:55pm. Please visit the PGC Calendar on our website for a full list of dates.

ONLY students WITH PERMISSION will be allowed to sign themselves in at the door with or without a parent/guardian present, please make a selection below.

Please Select a Pickup/Drop off option for your child

Self checkout: my child has permission to check themselves out at the conclusion of the program, with or without an adult present. Adult Checkout - My child will always be signed out by myself or other specified adult.

Unless otherwise noted, we will assume all parents and emergency contacts listed above are permitted to sign out your child during pickup at 7:55pm. Please provide any additional names of individuals permitted to pick up from Youth Group.

Description

Please complete one form for each of your children that will be participating in Youth Group.

PGC Grounded Youth Group 2026

Description

Please Fix the Following