PERMISSION SLIP FOR YOUTH ACTIVITIES SPONSORED BY
FIRST UNITED METHODIST CHURCH
22124 Garrison Street
Dearborn, Michigan 48124-2274
I give my permission for ______________________to attend the following
event sponsored by the U.M.Y.F. (United Methodist Youth Fellowship)
(List days, dates and name of event)
I hereby relieve the church and its agents from any responsibility or liability in case of injury. I also give my consent for emergency medical treatment, with the understanding that I shall be contacted as soon as possible. I also understand that myself or someone with legal guardian status will remain available by phone during the time the named youth is at the event.
Any known allergies ______________________________________________________
Medication Now Being Taken _______________________________________________
Complete Health insurance Information _________________________________________
Birth Date of Youth __________________ Relationship to Youth __________________
Date Signed __________________
Emergency Phone Number ___________________________ Please initial here if health information already on file is correct.