PERMISSION SLIP/RELEASE FORM
(print this and have your parent or guardian sign it!)
Name of Participant (youth): ________________________________________
Parent/Guardian’s name: ___________________________________________
In signing this form, I hereby give permission for my son/daughter to participate in Hopewell Presbyterian Church's Senior High Fellowship's “WINTERCAMP" trip to be held from Friday, February 2, 2001 through Sunday February 4, 2001. I also grant permission for my son/daughter to be transported in privately owned or rented vehicles. Further, I will not hold the church staff nor youth leaders, nor any of its representatives or Trustees responsible for any 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: ____________________________________
Policy Number: ___________________________________________________
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.