Youth Group Excursion Permission Slip

Participant Information

Name of Youth: Date of Birth: Address:

Parent/Guardian Information

Parent/Guardian Name: Contact Phone: Email:

Excursion Details

Event/Excursion Name: Date of Excursion: Location:

Medical Information

Allergies or Medical Conditions: Medications (if any):

Emergency Contact

Emergency Contact Name: Emergency Contact Phone:

Permission and Acknowledgement

I hereby give permission for my child named above to participate in the above-mentioned youth group excursion. By signing below, I acknowledge that I have provided all relevant medical information and emergency contact details.