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PERMISSION SLIP
As a parent/legal guardian of , I understand the information about the Lock In at Gateway City Church which is an overnight event that will end by and give permission for the subject of this release to be involved in the overall activities.
I/We will acknowledge that if the subject of the release has to return home early for discipline violations, it will be at my/our expense.
I/We understand all reasonable safety precautions will be taken at all times by GATEWAY CITY CHURCH and FRONTLINE agents during the events and activities I/We agree not to hold GATEWAY CITY CHURCH and FRONTLINE YOUTH, its leaders, employees, and volunteer staff liable for damages, losses, diseases, or injuries incurred by the subject of this form.
Meet at 7:00 PM at Gateway City Church on February 3, 2012 and go home at 9:30 AM February 4, 2012
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Parent/Guardian Name (Please Print) Student Name
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Parent /Guardian Signature Date
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Address/City/Zip (W) Phone#
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(H) Phone # Health/Med Ins. Co. and Policy Number
Please list on back of this Release Statement any allergies and/or medical conditions the subject of this release may have. Also list any prescription medication he/she may be taking at this time.
If you are under 18 you MUST have this signed to come!!
DATE: Friday, February 3rd and Saturday, February 4th 2012
TIME: Friday Starting 7:00 PM and Ending Saturday 9:30 AM
For any questions call Pastor John 917-698-1759 You can also fax the permission slip to 718-228-9363 No links found under this category.
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