FIRST UNITED METHODIST CHURCH OF CAIRO, GEORGIA

PARENT PERMISSION FOR SUPERVISED ACTIVITY

I, the parent or legal guardian of _______________________________________________

hereby give my permission for the above minor child to participate in the following activity:

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on ______________________________ (Date).

It is my understanding that all reasonable precautions and plans for the care and supervision of minor children will be taken.

I hereby relieve First United Methodist Church of Cairo, all employees of the First United Methodist Church of Cairo, and/or all volunteers representing the First United Methodist Church, both in their official capacity and as individuals, of any and all liability for injury sustained by the above named minor child while participating in this activity or while in transit to and from said activity.

The above named minor child has the following allergies or medical conditions:

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In the event treatment is required in the case of an emergency, I hereby grant my permission for the church chaperone(s) to secure the necessary medical attention.

Further, I agree to be responsible for payment of all expenses related to any medical treatment that shall be required by the child. The child is currently covered by the following medical insurance policy (company and policy number):

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Parent/Guardian Signature______________________________ Date ___________

Telephone Number ___________________

______ Please initial here if you DO NOT WANT any pictures of your child that may be taken during this activity, to be considered for possible publication in news items or on the Church Web Site.