Youth Group Off-Site Activity Permission Slip

Participant Information

Participant Name Date of Birth Address Parent/Guardian Name Parent/Guardian Phone Parent/Guardian Email

Activity Details

Activity Name Date of Activity Location Departure Time Return Time

Medical Information

Allergies / Medical Conditions Medications Emergency Contact Name Emergency Contact Phone

Permission and Release

I hereby give permission for my child to participate in the above activity. I understand that all reasonable precautions will be taken for safety. In case of emergency, I authorize the staff to secure medical care as needed.

Parent/Guardian Signature Date