Sign your youth's permission slip

Fill in your child's information and sign below. You'll receive the official, completed form — signed — for your records. Takes about three minutes on your phone.

The event

ActivityWalk With Me — youth temple walk

DateSaturday, July 11, 2026

RouteCanyon Park → Seattle Temple (19.4 mi)

Ward / StakeEastmont · Everett Stake

Activity leaderAlli Walker (YW)

1 Participant & contact Youth's full name *

Date of birth * Age *

Youth's phone (if any) Street address *

City * State *

Emergency contact — parent or guardian *

Primary phone * Secondary phone

2 Medical information

Kept confidential and shared only with leaders or medical personnel as needed to keep your youth safe.

Does the participant require a special diet?

Yes No

Does the participant have any allergies?

Yes No

List all prescription or OTC medications — leave blank if none

Can the participant self-administer their medication?

Yes No

3 Conditions & accommodations

Chronic or recurring illness?

Yes No

Surgery or serious illness in the past year?

Yes No

Any limits, restrictions, or disabilities we should know about for a 19-mile walk? Other needs or considerations for the planners

4 Permission & signature

By signing you consent to your youth's participation and travel, and authorize supervising adult leaders to obtain or provide emergency medical care. The full permission statement and the “Conduct at Church Activities” standards are part of the official form you're signing.

I have read and agree to the permission statement and Conduct at Church Activities on the official form. * The information above is accurate to the best of my knowledge. *

Parent or guardian signature *

Sign with your finger

Please sign before submitting.

When you tap below, we'll fill and sign the official permission form, download a copy to your phone, and send one to the leaders.