Permission Slip

Event Name:

Event Date:

Youth's Name:

Allergies or other conditions we should be aware of.

Parent or Guardian Contacting Information

Parent's (Guardian's) full name:

Address:

City, State & Zip Code:

Home: Cell: Work:

Your Email:

For Parents: During the activity, I may be reached at:

Address:

City, State & Zip Code:

Home/Cell Phone: Your Email:

If I cannot be reached in the event of an emergency, the following person is authorized to act in my behalf:

Name Relationship:

Home: Cell: Work:

Name Relationship:

Home: Cell: Work:

Physician’s Name Phone:

Physician’s Address:

Hospital Preference:

Family Medical/Hospital Insurance Policy #:

Echo Hill Presbyterian Church Photograph Release Form

Minor children need to have parent's or guardian's permission for EHPC to use any picture in which they appear on the EHPC web site or in other materials depicting minor children in Sunday School or Youth activities. If you mark yes, the undersigned party gives permission for Echo Hill Presbyterian Church to use such pictures. When signing for your minor child, put child's name in parentheses behind your signature. If you do not want your children's pictures on the Web Site or other church materials, please mark no on the space provided and sign your name.

Please note that if you select no, we may have to ask your child to not be included in any photography being done. Please explain this in advance to your child. Thank you.

Echo Hill Presbyterian Church has my permission to use any or all pictures in which my child appears for the Echo Hill Presbyterian Church Web Site.

Child's Name:  Yes No

Signature of Parent/Guardian:

Date:

I, the undersigned parent/guardian, consent to participation
of this youth in the event.

Parent/guardian:

Type your Signature:

Date:

Enter the code: