The permission slip is for a TJ Sr. Youth Group event called "Youth Game Day" taking place on Sunday, October 2nd from 1:00 PM to 6:30 PM at TJUC. The event will include challenge and leadership games led by Donald Taylor in the YOUNG ROOM, and will conclude with a pizza dinner in WESTON HALL. Parents must sign and return the permission slip by October 25th to give consent for their child to participate and authorize emergency medical treatment if needed.

1. TJ Sr. Youth Group Event Permission Slip
Youth Game Day, Sunday October 2nd
Permission Slip Due Date: Sunday, October 25th
Event Destination: TJUC
Starting Time and Place: 1:00 PM, YOUNG ROOM
Ending Time and Place: 6:30 PM, WESTON HALL
Adult 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 games
and activities led by Donald Taylor. We’ll wind up with a pizza dinner.
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(Please detach above for your records & turn in below portion on or before the due date)
Youth Game Day, Sunday October 2nd
I give my consent for my child, _______________________________, to participate
in the above mentioned event sponsored by _TJUC , I understand that the
church does not accept responsibility for any bodily injury incurred during this
event. I give permission for any emergency medical, surgical, diagnostic and
hospital care, treatment, and procedures to be performed by a licensed physician
or hospital when deemed immediately necessary or advisable by a physician to
safeguard my child’s health when I cannot be contacted. I agree to be responsible
for any expenses not covered by my insurance, which may be incurred as a result
of 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: _____________________