PERMISSION SLIP


	As a parent/legal guardian of                                          , I have reviewed the information about the                                       event, and give permission for the subject of this release to be involved in the overall activities.
	I/We have reviewed the rules of the activities and agree that the subject of this release will abide them. I/We also acknowledge that if the subject of the release has to return home early for discipline violations, it will be at my/our expense.
	I/We understand all reasonable safety precautions will be taken at all times by CHURCH/ORGANIZATION NAME and its agents during the events and activities.  I/We  authorize any treatment by an accredited hospital and/or physician deemed necessary for the subject of the release in case of an emergency. I/We understand the possibility of unforeseen hazards and know the inherent possibility of risk. I/We agree not to hold CHURCH/ORGANIZATION NAME, its leaders, employees, and volunteer staff  liable for damages, losses, diseases, or injuries incurred by the subject of this form.

                                                                                                            
Parent/Guardian Name (Please Print)			Student Name

                                                                                   
Parent /Guardian Signature					Date

                                                                                      
Address/City/Zip	

                                                                                      
(W) Phone #				(H) Phone #

                                                                                       
Health/Med. Ins. Co.				Policy Number


Please list  on back of this Release Statement any allergies and/or medical conditions the subject of this release may have.  Also list any prescription medication he/she may be taking at this time.