Parent Permission Form - First United Methodist Church Of Olympia printable pdf download

First United M ethodist Church of Olympia

Parent Permission/Waiver Form – Single Use

Parent or Guardian: Retain the upper portion for reference; complete the lower portion and return to

church office. Children/youth will need their parent or guardian’s permission to participate in an activity that is

held at a different time/place from the regular scheduled meeting, involving travel, unusual risk, controversial

topic, or waiver from the Safe-Church Policy. Parent or guardian signature indicates permission is given for the

activity/event indicated and that the whereabouts of your child is noted by parent or guardian.

FUMCO

Youth Group

is planning an event/activity (specify):

Date

Time

Location

EACH YOUTH MEMBER W ILL NEED:

Expense

Other equipment and/or clothing .

SPECIAL INFORMATION:

Unusual risk activity:

Controversial topic:

Waiver from Safe-Church Policy (be specific):

ARRANGEMENTS:

Departure time:

Place:

FUMCO

Return time:

Place:

FUMCO

Mode of transportation –

church van

private car

(underline one)

ADULTS ACCOMPANYING YOUTH/CHILDREN:

Name:

Home and/or cell Phone:

Name:

Home and/or cell Phone:

IN CASE OF EMERGENCY, SIGNIFICANT DELAY , OR REVISION OF PLANS, the leader will

notify a contact who will in turn notify parents. The contact person is:

Name:

Phone :

Leader signature and name

Phone:

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (cut here and return lower portion to the church) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

This portion of the form goes with the leader(s).

PERMISSION/W AIVER TO PARTICIPATE (No child will go on a trip without a signed permission

form.)

My son/daughter (name) ___________________________ has permission to participate in (waiver or activity)

____________________________________. If reasonable accommodations/allergy notification are needed,

please indicate here:

During the activity, I may be reached at (address) ________________________________ phone _____________

If I (we) cannot be reached in the event of an emergency, the following person is authorized to act on my (our)

behalf:

Name ___________________________________ Phone _____________ Address_________________________

Relationship to youth/child _________________________________________________

Physician’s Name ________________________________________ Phone _______________

Parent/guardian signature _______________________________________________ Date _________________

Parent Permission Form - First United Methodist Church Of Olympia

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