PERMISSION SLIP/RELEASE FORM
(print this and have your parent or guardian sign it!)
Name of Participant (youth):
Event name: _____________________________________
Approximate Event Start Time and Date: _________________________________
Approximate Event End Time and Date: _________________________________
In signing this form, I hereby give permission for my child whose name is above to participate in the event described above. I also grant permission for my son/daughter to be transported in privately owned or rented vehicles. Further, I will not hold staff nor youth leaders of Hopewell Presbyterian Church, nor any of its representatives or Trustees responsible for any damages or injuries sustained during the course of activities for the above dates and times.
In case of a medical emergency, I understand
that every effort will be made to contact the parent/guardian of
the young person. In the event that I cannot be
reached, I hereby give permission to the physician selected by
the staff or person designated by the staff to give medical
attention to my child, as named herein.
Family Health Insurance Company:
Telephone #s where I can be reached:
Signature of Parent/Guardian:
Any medical or other health-related problems
we should be aware of:
Note: We must have a permission slip
for each person attending this event. If you do not have
your permission slip, you will not be permitted to
attend. Sorry, but we have to be sure you have permission
and the needed medical data in case of an emergency.
Another Note: Unless you are a leader,
you must have this signed by a parent.
Questions? Call Chris Kile at 609-466-0758 (church) or 609-466-6444.