Permssion Form

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PERMSSION FORM
Permission form must be turned in order for your child to attend
I give permission for my child ________________________ (name) to attend the ______________ (event)
on ____/____/ _____ (date)
Please check to see if your child needs to bring money
Is the anything we should know (allergies, restrictions, etc.):
Emergency contact:
Name:
Phone:
In case of an emergency, I give permission for my child to receive medical treatment.
Parent/Guardian signature
Date
If you have any question or concerns feel free to contact Brandon Dasilva
Email:
Cell Phone: (717) 341-3796
Stumptown Mennonite Church, 2813 Stumptown Rd Bird-in-hand, PA 17505

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