Pine Forest United Methodist Church
Friday, April 18, 2014

Permission Slip for All Off-Campus Activities

Youth Permission Slip for All Off-Campus Activities

 
REGISTRATION FORM
     (One per YOUTH)
 
 
 
 
NAME:  AGE:
 
GRADE IN NOW:                              
 
STREET ADDRESS: CITY:  
 
STATE:  ZIP CODE: 
 
HOME TELEPHONE NUMBER:
 
EMAIL ADDRESS:
 
PARENT/GUARDIAN NAME(S):
 
CELL PHONE NUMBER(S):
 
 
PEOPLE AUTHORIZED TO PICK UP THE YOUTH:
 
NAME: 
 
                                                      CONTACT NUMBER:
 
RELATIONSHIP TO CHILD:  
 
 
IN CASE OF EMERGENCY CONTACT (other than parent):
 
NAME:
 
                                                     CONTACT NUMBER


 
 ALLERGIES OR OTHER MEDICAL CONDITIONS?
 
 
 
 
PARENT/GUARDIAN SIGNATURE: ___________________________________________________________
 
 
 
**These slips must signed for EACH AND EVERY off-campus event.  Once you have filled out one of these initially, each sequential form please fill out youth name, phone information, pick up information and signature.