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T J Y G Permission Youth Game Day 10.2.11

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Please complete and send to DRE Barb electronically PDQ!

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T J Y G Permission Youth Game Day 10.2.11

  1. 1. TJ Sr. Youth Group Event Permission Slip Youth Game Day, Sunday October 2ndPermission Slip Due Date: Sunday, October 25thEvent Destination: TJUCStarting Time and Place: 1:00 PM, YOUNG ROOMEnding Time and Place: 6:30 PM, WESTON HALLAdult Sponsors for this event:Name: BARB FRIEDLAND Phone 425-6943 (CELL 548-5006)Name: (2nd person pending) Phone: _____________________________Additional Information: The event includes a challenge and leadership gamesand activities led by Donald Taylor. We’ll wind up with a pizza dinner.---------------------------------------------------------(Please detach above for your records & turn in below portion on or before the due date)Youth Game Day, Sunday October 2ndI 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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