2010 Missions Permission Slip

 copy & paste to a word document & print

Emergency Waiver:

  I hereby give my son/daughter ___________________________ permission to Attend The JBC one day missions opportunity on  March  14  or  April 11th  (circle one)

I release and hold harmless Jaffrey Bible Church and its youth leaders from any and all actions of any nature of personal injury arising from my child's participation in this activity.

I, therefore grant permission for first aid to be administered, proper treatment and/or hospitalization to be secured for my child in case of emergency according to the best judgment of the youth leaders and other adults on site.

List any medical concerns your child has (if none, state so):

______________________________________________________________________

Phone # you can be reached at ______________________ cell ____________________

Alternate contact (name and phone) if you are unavailable:

Name___________________________ phone_________________________________

Signature of parent/guardian __________________________________________

Printed name of parent/guardian _______________________________________

Date ______________________________

Students may not attend without this permission slip Signed

Cost is $0