Event Permission Form

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: ______________