Permission Slip for Youth

Activity:__________________________

Date of Activity: ________________

Name:____________________________ Phone:_________________ Grade:_______

Street Address: __________________________________________________________

City:_____________________________ State:______________ Zip Code:_________

Parent/Guardian Permission

As the custodial parent/guardian I hereby give my permission for________________

To attend the FUMC Youth __________________________________ on___________

(activity name) (date of activity)

I give my consent for my child to be transported to and from the event with the adult leaders.

____________________________________________________________ ___________

Signature of parent/guardian Date

Medical Release

My child,________________________ is in good health. In case of medical emergency, I give my permission for the Adult Leaders of the FUMC Youth Group to secure treatment for, hospitalize, and order any medical procedures deemed necessary for the health of my child.

_____________________________________ _________ ________________________

Signature of parent/guardian Date Printed name

Phone #'s where you can be reached:

________________________ ______________________ ________________________

Home Work Cell

Other emergency contact: (In case we can't reach you)

_________________________________ ___________________ ________________

Name Relationship Phone #

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