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Youth Permission Slip

Name of Student
Address
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry

Father or Guardian's Name
Mother or Guardian's Name
Parent's Cell Phone *
Parent's Email *
Parental Permission *
I give permission for my youth to participate in the above event. If emergency medical treatment is required, I give permission to the church staff or adult volunteers to obtain the services of a licensed physician. I will be notified as soon as possible concerning any such emergency. By typing my name here, I am electronically signing this form.
Medical Information Medical Insurance Note: For security purposes, we do not collect medical insurance information through our online form. You will be contacted by the church office shortly after registration is completed to provide medical insurance information for your child.
Media Release *
When participating in church activities, your child may be photographed for print, videotaped, or electronically imaged. Images may be used in promotional materials, news releases, and other published formats for Sterling UMC. The images are the sole property of Sterling UMC. If you do not want your child's image used, please check 'No."YesNo