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T J  Y G  Permission   First  U  Visit 10.9.11
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T J Y G Permission First U Visit 10.9.11

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Permission form due date is 10/2/11

Permission form due date is 10/2/11


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  • 1. TJ Sr. Youth Group Event Permission Slip Visit to First Unitarian, Sunday October 9thPermission Slip Due Date: Sunday, October 2ndEvent Destination: First Unitarian ChurchStarting Time and Place: 10:15 AM, SHARP FOR CARPOOL FROM TJUCEnding Time and Place: 3:00 PM, TJUCAdult Sponsors for this event:Name: BARB FRIEDLAND Phone 425-6943 (CELL 548-5006)Name: (2nd person pending) Phone: _____________________________Additional Information: TJUC youth are invited to attend a youth led service atFirst U about their recent Youth Mission Trip to New Orleans. Please bring asack lunch, labeled with youth’s name, including beverage (refrigeration isavailable). There will be a weather dependent service project outdoors afterward.Youth should dress for outdoor conditions.---------------------------------------------------------(Please detach above for your records & turn in below portion on or before the due date)First Unitarian Visit, Sunday October 9thI give my consent for my child, _______________________________, to participatein the above mentioned event sponsored by _TJUC , I understand that thechurch does not accept responsibility for any bodily injury incurred during thisevent. I give permission for any emergency medical, surgical, diagnostic andhospital care, treatment, and procedures to be performed by a licensed physicianor hospital when deemed immediately necessary or advisable by a physician tosafeguard my child’s health when I cannot be contacted. I agree to be responsiblefor any expenses not covered by my insurance, which may be incurred as a resultof an accident or medical emergency involving my child.Parent/Guardian Signature: ________________________________ Date: ________PLEASE ATTACH COPY OF INSURANCE INFORMATION to this sheet.My child has the following allergies, dietary restrictions, or medical conditions:(please use back of sheet if need) _______________________________________________________________________________________________________________________Emergency contact information:Primary - Name: __________________________ Phone: H: ____________________ Cell: _________________________Secondary – Name: __________________________ Phone: _____________________

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