Please fill in all applicable spaces to the best of your ability.
EMERGENCY CONTACT INFORMATION (Other than parent/guardian)
I, the parent/guardian of the above mentioned youth acknowledge the risks associated with my child participating in any events, programs, and activities scheduled with the Lloydminster Community Youth Centre (LCYC), a division of the Lloydminster Interval Home Society (LIHS). I acknowledge that programming may occur within a 50-km service area of Lloydminster AB/SK and may require the transportation of my child in LCYC vehicles.
Please check off to indicate consent on the following: