Permission Slip
Need a Permission Slip? Here you go!
Permission Slip for Youth Ministry Events. If you have problems with the link then you may cut & paste this into Word and go from there.
Permission Slip For
Grace Bible Youth Event
_______________________
(Event Name)
Child’s Name _________________________
(If more than one child from your family is participating you may give all of their names.)
Phone # ______________
I give permission for my above named child(ren) to join the Youth Ministry of Grace Bible Church to participate in the above stated event, on ____________ 200__.
I know that they will be traveling to and from the event in the church van and/or in church-approved vehicles with adults who are approved drivers.
I hereby release Grace Bible Church, its staff and sponsors, from responsibility and liability for any injury or illness that my child may sustain during this activity. In the event of an emergency, I hereby authorize an adult leader of this activity, as agent for me, to consent to any X-ray examination; medical, dental or surgical diagnosis; treatment; and hospital care advised and supervised by a physician, surgeon or dentist (as appropriate) licensed to practice under the laws of the state where the services are rendered, either at a doctor’s office or in any hospital. I expect to be contacted as soon as possible.
Signature of parent or legal guardian ______________________
Date _____________________
Emergency phone number _______________________________
Secondary Emergency phone number _______________________
MEDICAL INFORMATION
Allergies _______________________________________
Medications being taken ____________________________
Physical handicaps or limitations ______________________
Medical insurance company _____________________
Policy Number ____________________
Member’s name _________________________________