Event Permission Form
Please print in ink
EVENT: _______________________________________________ DATE: ______________________
Youth’s Name: _____________________________________________________________________________
Last First Middle
Age _________ Birthday _________________ Grade ____________ q Male q Female
Address _________________________ City_____________ State ______ Zip ____________
Youth’s Cell _______________________ Email __________________________________
Mother’s name _________________________________________________________________
Phone: Home _____________________________ Cell ______________________________
(Guardian’s)
Father’s name _________________________________________________________________
Phone: Home _____________________________ Cell ______________________________
Emergency contact _____________________________________________________________
Phone: Home _____________________________ Cell ______________________________
For your information, we expect each student to conform to these rules of conduct
Respect God
Respect others
Respect yourself
I, the student, have read the rules of conduct and permission to participate in Rm. 56 activities. I agree to abide by the stated personal limitations and code of conduct.
Student signature: ___________________________________________ Date:______________
I/We the undersigned have legal custody of the student named above, a minor, and have given our consent for him/her to attend this event/activity being organized by the Church. I/We understand that if my youth fails to comply with the expectations listed above in the rules of conduct, the youth under me will be sent home at my expense. I/We understand that there are inherent risks involved in any ministry or athletic event. I/We understand that while my youth is at this event they will follow the previous rules of conduct and are under the authority of the Children’s Ministry Director and any other adult volunteers named.
Parent/guardian signature: ____________________________________ Date: ______________