Youth Group Overnight Trip Permission Slip

Participant Information

Participant Name

Date of Birth

Gender

Address

Parent/Guardian Information

Parent/Guardian Name

Relationship

Phone Number

Trip Details

Trip Date

Destination

Meeting Location & Time

Emergency Information

Emergency Contact Name Emergency Contact Phone Doctor's Name Doctor's Phone Medical Conditions / Allergies Medications Insurance Provider Policy Number

Consent & Acknowledgement

I, the undersigned parent/guardian, give permission for my child to attend the youth group overnight trip as detailed above. I authorize the leaders to seek medical treatment if necessary. I understand all reasonable safety precautions will be taken.

Parent/Guardian Signature

Date