Church Youth Retreat Permission Slip
Event Information
Event Name
Date(s)
Location
Participant Information
Participant Name
Date of Birth
Address
Parent/Guardian Name
Phone Number
Email
Medical Information
Allergies / Medical Conditions
Medications
Insurance Information
Emergency Contact Name & Number
Permissions & Consent
I hereby give permission for my child to attend the above-named youth retreat and to participate in all activities. In the event that I cannot be reached in an emergency, I give permission for the group leader to make medical decisions for my child as necessary.
Parent/Guardian Signature
Date