Child/Youth Name:

Emergency Contact Person:

v    Telephone:

v    Mobile Phone:

Allergies/Medical Information:

 

Insurance Information:

 

The child/youth designated above, has my permission to attend the B.F.U.M.C. off-campus function described on this form. If changes are made to the above stated itinerary or chaperones, I will be notified in advance. By signing this form, I am stating that I am the parent or legal guardian of the child/youth named above.

The child/youth designated above, has my permission to attend the B.F.U.M.C. off-campus function described on this form. If changes are made to the above stated itinerary or chaperones, I will be notified in advance. By signing this form, I am stating that I am the parent or legal guardian of the child/youth named above.

Signature:                                                           

 

Printed Name:    

                                                Relationship:

I give permission for the church to place my child’s picture on the church website.  No names will be posted.   Signed : ___________________________________________  Date _______________